Dislocation of patella

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Dislocation of patella

  1. 1. Dislocation Of Patella.
  2. 4. Types <ul><li>Acute </li></ul><ul><li>Recurrent </li></ul><ul><li>Habitual </li></ul>
  3. 6. 1. Acute <ul><li>Result 4m sudden contraction of quadriceps while the knee is flexed or semi-flexed. </li></ul><ul><li>Dislocates laterally </li></ul><ul><li>C/F: </li></ul><ul><ul><li>Pain </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><ul><li>Unable to straighten the knee </li></ul></ul><ul><ul><li>Medial condyle(Femur)  more prominent </li></ul></ul><ul><ul><li>Tenderness (antero-medially) </li></ul></ul>
  4. 7. Treatment: <ul><li>Reduction- Under Gen. anesthesia </li></ul><ul><li>Immobilisation: cylinder cast—3 weeks </li></ul>
  5. 8. Recurrent D/L <ul><li>Etiology: </li></ul><ul><ul><li>Congenital </li></ul></ul><ul><ul><ul><li>Lig. Laxity </li></ul></ul></ul><ul><ul><ul><li>hypoplasia of lat. Femoral condyle </li></ul></ul></ul><ul><ul><ul><li>Flattening of Intercondylar groove </li></ul></ul></ul><ul><ul><ul><li>Patellar maldevelopment </li></ul></ul></ul><ul><ul><ul><li>Primary muscle defect </li></ul></ul></ul><ul><ul><ul><li>Genu valgum </li></ul></ul></ul><ul><ul><li>Acquired </li></ul></ul><ul><ul><ul><li>Genu valgum </li></ul></ul></ul><ul><ul><ul><li>Inequality of growth of condyle </li></ul></ul></ul><ul><ul><ul><li>Weakness of Quads </li></ul></ul></ul><ul><ul><ul><li>Contracture </li></ul></ul></ul><ul><ul><ul><li>fibrosis </li></ul></ul></ul>
  6. 11. Pathology <ul><li>First episode </li></ul><ul><li>Tear of capsule on medial side of patella </li></ul><ul><li>If improper healing </li></ul><ul><li>Persistent laxity </li></ul><ul><li>Recurrent d/l </li></ul><ul><li>Damage to contiguous surface of patella & fem. Condyles </li></ul><ul><li>Flattening & then further d/l </li></ul>
  7. 12. C/F <ul><li>More common in girls </li></ul><ul><li>Often B/L </li></ul><ul><li>Acute pain with knee stuck in flexion </li></ul><ul><li>In dislocated state: </li></ul><ul><ul><li>Visually obvious </li></ul></ul><ul><ul><li>Tenderness </li></ul></ul><ul><ul><li>Swelling </li></ul></ul><ul><li>Between attack </li></ul><ul><ul><li>Patella alta </li></ul></ul><ul><ul><li>Gen. lig. Laxity </li></ul></ul><ul><ul><li>Apprehension test +ve </li></ul></ul>
  8. 13. Investigation: <ul><li>X-ray </li></ul><ul><ul><li>Dislocation </li></ul></ul><ul><ul><li>High-riding patella </li></ul></ul><ul><ul><li>Other anatomical abnormality </li></ul></ul><ul><li>MRI </li></ul><ul><li>CT-SCAN </li></ul>
  9. 18. Treatment <ul><li>Conservative </li></ul><ul><ul><li>Quads exercise </li></ul></ul><ul><ul><li>NSAIDS </li></ul></ul><ul><li>Operative </li></ul><ul><ul><li>Camphell Op. </li></ul></ul><ul><ul><li>Goldwait op. </li></ul></ul><ul><ul><li>Hauser’s op. </li></ul></ul><ul><ul><li>Patellectomy </li></ul></ul><ul><ul><li>Muscle release with V-Y Z-plasty </li></ul></ul>
  10. 22. Habitual D/l <ul><li>Everytime knee is flexed, It dislocates laterally </li></ul><ul><li>Present in early childhood </li></ul>
  11. 23. Thank You

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