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7.Knee injury ( Diagnosis???). 7.Knee injury ACL,PCL,MCL injury -common ACL,PCL,MCL injury -common fracture fracture Contact sport Contact sport.

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Presentation on theme: "7.Knee injury ( Diagnosis???). 7.Knee injury ACL,PCL,MCL injury -common ACL,PCL,MCL injury -common fracture fracture Contact sport Contact sport."— Presentation transcript:

1 7.Knee injury ( Diagnosis???)

2 7.Knee injury ACL,PCL,MCL injury -common ACL,PCL,MCL injury -common fracture fracture Contact sport Contact sport

3 Knee anatomy 3 bone Patella Patella Tibia Tibia femur femur

4 1.Ligament 1.Anterior cruciate ligament(ACL) 2.Posterior cruciate ligament(PCL) 3.Medial collateral ligament(MCL) 4.Lateral collateral ligament(LCL ) 4.Lateral collateral ligament(LCL )

5

6 2.meniscus Medial, lateral meniscus Medial, lateral meniscus function function 1.Transmit load and distribution 1.Transmit load and distribution 2.Increase contact surface area 2.Increase contact surface area

7 Knee anatomy

8 Mechanism injury Pivot sport ( soccer, basketball rugby) Pivot sport ( soccer, basketball rugby) Decelerate, jumping Decelerate, jumping Hyperextend Hyperextend rotate rotate Pop sound ( ACL torn) Pop sound ( ACL torn)

9 Clinical Pain,cannot walk Pain,cannot walk Swelling Swelling hematrosis hematrosis

10 Knee Exam Deformity Deformity Swelling, ballotment Swelling, ballotment Tender - joint line Tender - joint line ROM – Flex,extend ROM – Flex,extend Muscle –quadricep Muscle –quadricep Special test for ligament Special test for ligament

11 1.Valgus stress test – Medial collateral ligament ( MCL)

12 2.Varus stress test – lateral collateral ligament ( LCL) Varus stress test in flex 30,full extend Varus stress test in flex 30,full extend

13 3.Lachman test for ACL (Anterior cruciate ligament)

14 3.Anterior drawer test (ADT) for ACL (Anterior cruciate ligament)

15 .Posterior cruciate ligament (PCL) 4.Posterior drawer test for.Posterior cruciate ligament (PCL)

16 treatment On – field On – field - RICE ( ligament injury) - RICE ( ligament injury) - splint ( fracture) - splint ( fracture) Ligament injury Ligament injury - long leg cast (MCL) 4-6week - long leg cast (MCL) 4-6week - surgery – 1.Repair - surgery – 1.Repair - 2.Reconstruction - 2.Reconstruction ( 6 week – 6 month) ( 6 week – 6 month)

17 Ligament Reconstruction ACL Reconstruction ACL Reconstruction

18 Post operation Post operation -Hinge knee brace -Hinge knee brace -Axillary crutch -Axillary crutch

19 Meniscus injury

20 Meniscus tear

21 Arthroscopic repair

22

23 8.Leg injury Diagnosis ?? Diagnosis ??

24 Anatomy leg 2 bone 2 bone 1.Tibia ( weight bearing) 1.Tibia ( weight bearing) Tibia plateau – proximal (knee) Tibia plafond – distal (ankle) 2.Fibula (non weight bearing) 2.Fibula (non weight bearing)

25 8.Leg injury Common Common Twist, direct injury Twist, direct injury Contact sport ( soccer,rugby) Contact sport ( soccer,rugby)

26 8.1Fracture tibia and fibula Severe pain Severe pain Deformity Deformity Shortening Shortening Aware open fracture Aware open fracture(Emergency) Neurovascular Neurovascular

27 treatment On-field On-field – long splint,transport – long splint,transport - clean wound - clean wound Definite Definite - long leg cast week - long leg cast week - Surgery in displaced fracture - Surgery in displaced fracture ( 3-6 month) ( 3-6 month)

28 Surgery with Intramedullary Nail (tibia)

29 Surgery with External fixator in dirty open fracture tibia

30 Diagnosis ???

31 8.2 Muscle cramp Common injury Common injury Calf pain, tender Calf pain, tender Cause – electrolyte imbalance Cause – electrolyte imbalance - dehydration - dehydration - muscle contraction imbalance - muscle contraction imbalance

32 8.2 Muscle cramp Muscle contraction imbalance

33 treatment Passive stretching Passive stretching IV fluid IV fluid Check electrolyte Check electrolyte

34

35 9.Ankle injury Diagnosis??? Diagnosis???

36 Ankle anatomy 3 bone 3 bone 1.distal tibia,medial malleolus 1.distal tibia,medial malleolus 2.distal fibula,lateral malleolua 2.distal fibula,lateral malleolua 3.talus 3.talus Ligament Ligament 1.medial – deltoid ligament 1.medial – deltoid ligament 2.lateral – ATFL,PTFL,CFL 2.lateral – ATFL,PTFL,CFL

37 Ankle anatomy

38 9.Ankle injury Most common Most common Twist, direct injury Twist, direct injury Soccer,basketball Soccer,basketball 1.ligament injury 1.ligament injury -Inversion lateral ankle sprain -Inversion lateral ankle sprain 2.Fracture ankle 2.Fracture ankle

39 9.1 Ankle sprain Mechanism injury Mechanism injury Inversion (common) Inversion (common) Lateral injury,tear Lateral injury,tear Pain Pain Swelling Swelling Cannot walk Cannot walk

40 Ankle sprain

41 Treatment On field On field - RICE - RICE Definite treatment depend on grade of injury Definite treatment depend on grade of injury

42 Grading of ankle sprain Grade 1 (mild) – pain,tender Grade 1 (mild) – pain,tender Grade 2 (partial tear) Grade 2 (partial tear) - pain,swelling - pain,swelling - marked tender - marked tender - good stability - good stability

43 Treatment in Grade 1,2 Ankle support Ankle support Brace Brace Elastic bandage Elastic bandage Splint (2-6 week) Splint (2-6 week)

44 Grade 3 (complete tear) Marked pain,swelling Marked pain,swelling Instability Instability Cannot walk Cannot walk Treatment Treatment 1.brace, cast 1.brace, cast 2.surgery if instability or chronic 2.surgery if instability or chronic

45 9.2 Fracture ankle Tender,pain,swelling Tender,pain,swelling Deformity Deformity Aware open fracture Aware open fracture Neurovascular – post tibia a,n Neurovascular – post tibia a,n

46 Fracture ankle

47 treatment 1.On field - splint 1.On field - splint Reduction if marked deformity Reduction if marked deformity - Direct traction for prevent neurovascular - Direct traction for prevent neurovascular 2. Surgery 2. Surgery ( 8-12 week) ( 8-12 week)

48 Rehabilitation ROM ROM Strength Strength resist resist

49 THANK YOU Question ???


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