1/4. Superior dislocation of the patella. Case report and review of literature.Superior dislocation of the patella is a rare diagnosis, which usually occurs after a trivial trauma. It usually requires manipulation with analgesics or may even need anaesthesia. We report a case of spontaneous reduction of the dislocation, which lead us to believe that this may be more common in the community than has been reported.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/4. Injuries to the posterior cruciate ligament of the knee.The posterior cruciate ligament (PCL) is the strongest ligament about the knee and is approximately twice as strong as the anterior cruciate ligament. Its main function is to prevent the posterior dislocation of the tibia in relation to the femur, providing 95% of the strength to resist the tibial posterior displacement. Along with the anterior cruciate ligament (ACL) the PCL controls the passive 'screw home' mechanism of the knee in terminal knee extension. It also provides mechanical support for the collateral ligaments during valgus or varus stress of the knee. PCL ruptures are uncommon apparently due to its strong fibre structure. The most frequent injury mechanism in isolated PCL tears is a direct blow on the anterior tibia with the knee flexed thus driving the tibia posteriorly. Automobile accidents (in which the knee hits the dashboard) and soccer injuries (in which an athlete receives a blow to the anterior surface of the tibia during knee flexion) characteristically produce this type of injury. In other PCL injury mechanisms (hyperextension, hyperflexion or rotational injuries with associated valgum/varum stress), other knee structures are also often damaged. The most characteristic diagnostic finding in a knee with a PCL rupture is the 'posterior sag sign' meaning the apparent disappearance of the tibial tubercle in lateral inspection when the knee is flexed 90 degrees. This is due to gravity-assisted posterior displacement of the tibia in relation to the femur. A positive posterior drawer test performed at 90 degrees of flexion and a knee hyperextension sign are sensitive but nonspecific tests. False negative findings are frequent, especially in acute cases. If necessary, the clinical diagnosis of the PCL tear can be verified by magnetic resonance imaging, examination under anaesthesia, arthroscopy, or a combination of these modalities. If a PCL avulsion fragment has been dislocated, surgical treatment is recommended. In isolated, complete midsubstance tears of the PCL the majority of the recent studies recommend conservative treatment, since abnormal residual posterior laxity1 in most of these knees is consistent with functional stability and minimal symptoms. This has been the case even in athletes. In isolated PCL tears, the outcome seems to depend more on the muscular (quadriceps) status of the knee than on the amount of residual posterior laxity. Therefore, the conservative treatment protocol emphasises intensive quadriceps exercises, and only a short (under 2 weeks) immobilisation period followed by early controlled activities and early weightbearing.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/4. Fatal paradoxical thrombo-embolism during anaesthesia.Deep venous thrombosis is a recognised complication of trauma to the leg and may lead to pulmonary thrombo-embolism, but paradoxical thrombo-embolism is rare. A case of fatal paradoxical thrombo-embolism which followed a leg injury in a previously fit 36-year-old male is presented and contributory factors are reviewed.- - - - - - - - - - ranking = 4keywords = anaesthesia (Clic here for more details about this article) |
4/4. knee ligament injuries.Better knowledge of pathomechanics and clinical features together with more widespread use of stressing the knee under anaesthesia and arthroscopy makes easier the diagnosis of acute knee ligament and associated injury. Careful analysis of the symptoms of chronic instability points to the hitherto neglected anterior cruciate ligament rupture as a significant knee ligament injury often causing giving-way of the knee. Prompt treatment of knee ligament rupture may offer the only hope against the irreversible injury to other knee structures caused by continuing instability.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |