Congenital Dislocation Of The Knee - Everything You Need To Know - Dr. Nabil Ebraheim скачать в хорошем качестве

Congenital Dislocation Of The Knee - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describing the condition of congenital dislocation of the knee. Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Congenital dislocation of the knee is rare. The condition may occur due to quadriceps contracture. It usually occurs in patients with myelo, arthrogryposis, or Larsen’s syndrome. The patient with congenital dislocation of the knee may have developmental dysplasia of the hip (DDH) and club foot. On examination, the patient will have a hyperextended knee at birth. The patient’s foot could be placed against the face. There will be limited flexion at the knee. The patient may have a dimple or skin crease at the anterior aspect of the knee. You must examine the hip to rule out ipsilateral hip dislocation. 50% or more will have hip dysplasia. The etiology is not known, however it could be due to fetal positioning or congenital absence of the cruciate. Patient may have contracture of the quadriceps. There are grades or a spectrum for the deformity. Grade one is severe Genu Recurvatum(knee hyperextended). If the range of passive flexion is more than 90 degree and that is simple recurvatum. Grade two is subluxation (30 degree to 90 degree range of passive flexion). Grade three complete dislocation (less than 30 degree of passive flexion). Treatment can consist of the pavlik harness and club foot cast will require knee flexion, so you need to work on treating the knee dislocation first. Grade one will be stretching of the knee and serial casting with the knee in flexion. The goal is to obtain at least obtain at least 90 degrees of flexion and reduction of the deformity over the course of several weeks. The physician should avoid pseudo-correction through an iatrogenic fracture of the proximal tibial physis. The prognosis is usually good if reduction is achieved without surgery. For grade 2, if the infant is less than 1 month old, you will do serial casting first followed by percutaneous quadriceps recession especially if the flexion is less than 90 degrees. V-y quadricepsplasty with above the knee cast is done in grade 3 especially if non-surgical treatment fails to reduce the tibia on the femur. The result of open surgery is better when it is done in children younger than 6 months. In general, open reduction is reserved for children who did not respond to stretching cast immobilization. It is important that the hip dysplasia is recognized and the knee dislocation is corrected early. This will help in early reduction of the hip.