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Patella dislocation with vertical axis rotation: the "dorsal fin" patella.

Gamble D, Otto Q, Carrothers AD, Khanduja V - Case Rep Orthop (2015)

Bottom Line: Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation.Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint.In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

View Article: PubMed Central - PubMed

Affiliation: Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hill Road, Cambridge CB2 0QQ, UK.

ABSTRACT
A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a "dorsal fin" appearance of the soft tissues tented over the patella. This was diagnosed as a rare case of an intraarticular patella dislocation, which was rotated 90 degrees about the vertical axis. Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation. Postreduction arthroscopy demonstrated that no osteochondral or soft tissue damage to the knee had been sustained. In patients presenting with a knee locked in extension with tenting of skin over the patella (the "dorsal fin" appearance), intra-articular patella dislocation should be suspected. Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint. In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

No MeSH data available.


Related in: MedlinePlus

Lateral radiograph of the knee. The knee is held in extension and the patella is rotated 90 degrees.
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fig4: Lateral radiograph of the knee. The knee is held in extension and the patella is rotated 90 degrees.

Mentions: The AP radiograph revealed a laterally dislocated patella. The lateral radiograph showed an abnormal appearance with the rotated patella impacted in the intercondylar notch of the femur (Figures 3 and 4). In the accident and emergency department one unsuccessful attempt at closed reduction was made under procedural sedation with propofol and fentanyl. The knee joint was fully extended and an attempt was made to manipulate the patella to rotate it back to its normal orientation.


Patella dislocation with vertical axis rotation: the "dorsal fin" patella.

Gamble D, Otto Q, Carrothers AD, Khanduja V - Case Rep Orthop (2015)

Lateral radiograph of the knee. The knee is held in extension and the patella is rotated 90 degrees.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4390077&req=5

fig4: Lateral radiograph of the knee. The knee is held in extension and the patella is rotated 90 degrees.
Mentions: The AP radiograph revealed a laterally dislocated patella. The lateral radiograph showed an abnormal appearance with the rotated patella impacted in the intercondylar notch of the femur (Figures 3 and 4). In the accident and emergency department one unsuccessful attempt at closed reduction was made under procedural sedation with propofol and fentanyl. The knee joint was fully extended and an attempt was made to manipulate the patella to rotate it back to its normal orientation.

Bottom Line: Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation.Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint.In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

View Article: PubMed Central - PubMed

Affiliation: Trauma and Orthopaedic Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hill Road, Cambridge CB2 0QQ, UK.

ABSTRACT
A 44-year-old woman presented following minor trauma to her right knee. While dancing she externally rotated around a planted foot and felt sudden pain in her right knee. She presented with her knee locked in extension with a "dorsal fin" appearance of the soft tissues tented over the patella. This was diagnosed as a rare case of an intraarticular patella dislocation, which was rotated 90 degrees about the vertical axis. Closed reduction in the emergency room was unsuccessful but was achieved in theatre under general anaesthetic with muscle relaxation. Postreduction arthroscopy demonstrated that no osteochondral or soft tissue damage to the knee had been sustained. In patients presenting with a knee locked in extension with tenting of skin over the patella (the "dorsal fin" appearance), intra-articular patella dislocation should be suspected. Attempts to reduce vertical patella dislocations under sedation with excessive force or repeatedly without success should be avoided to prevent unnecessary damage to the patellofemoral joint. In this clinical situation we recommend closed reduction under general anaesthetic followed by immediate knee arthroscopy under the same anaesthetic to ensure that there is no chondral damage to the patella or femoral trochlea and to rule out an osteochondral fracture.

No MeSH data available.


Related in: MedlinePlus