Module 38, General Medical Level
A 14 year old Hispanic male presented to the emergency room after sustaining
a hyperextension injury to his right knee during a soccer collision. He
had the immediate onset of pain and noted swelling of the knee during the
first hour after injury. He was unable to bear weight; flexion and extension
of the knee exacerbated the pain. He had no previous history of injury
to his right lower extremity. Examination of the right lower extremity
was remarkable for a knee effusion with soft tissue swelling and diffuse
tenderness at the proximal tibia. The patient was unable to dorsiflex or
evert his foot. Sensation along the lateral calf and foot was diminished.
The dorsalis pedis and tibialis anterior pulses were palpable and there
was good distal capillary refill. AP and lateral views of the right lower
extremity revealed a Salter Harris III proximal tibial fracture with intraarticular
extension into the medial and lateral tibial plateaus. The epiphysis was
anteriorly displaced on the metaphysis.
Question 38A
This is a relatively simple fracture and should easily be able to be reduced
and have a good outcome.
Question 38B
The
loss of sensation means that he probably had his nerves contused by the
direct blow of the original trauma.
Question 38C
The
presence of distal pulses means that the artery was not damaged therefore
a very severe injury was avoided.
Question 38D
This
type of injury is often associated with a hip injury, therefore a pelvis
x-ray should also be obtained.
Question 38E
If
you are uncertain about the presence of distal pulses a Doppler examination
is a good way to document that there is an adequate pulse.
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