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Author Topic: HELP! Accidental fall-complex knee injury complicated by DVT / nerve damage  (Read 2626 times)

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Offline newpatient

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My husband had a serious and dramatic fall 4 weeks ago on concrete (involved an aerial somersault!!) and suffered serious left knee damage.  The MRI done 4 days after the fall showed:

Partial tear proximal posterior cruciate ligament.  There is high-grade tear of the proximal and mid anterior cruciate ligament with subtle edema throughout the fibers.  No translation of the tibia.  No contusions.  Popliteus tendon is intact.  Iliotibial band is intact.  There is subactute osseous avusion of the conjoined tendon on the fibular head.  There is scarring of the capsule with suggestion for subtle Segond fracture.  Medial collateral ligament is intact.

Subtle undersurface tear junction of posterior horn and body of the lateral meniscus. No tear medial meniscus.  No cartilage defect medial joint, trochlea or lateral joint.  Patellar cartilage is intact.

Minimal effusion.  Popliteal cyst with rupture and extensive soft tissue edema.  Marrow edema anterior medial femur compatible with contusion.

IMPRESSION:

Subacute osseous avulsion of the conjoined tendon off the proximal fibula.  Contusion anterior medial femur. Suggestion for subtle Segond fracture with injury to the capsule at its insertion on the tibia.

Subtle tear lateral meniscus.

Complete proximal and mid anterior cruciate ligament tear with no translation of the tibia.  Partial tear proximal posterior cruciate ligament.

--------------------------------------

As if all of this damage wasn't enough, the day after this was done, I (his wife - an ultrasound tech for 15 years!) decided that his leg was too swollen to ignore, so I did my own Doppler exam and found posterior tibial thrombus from ankle to just below the knee!  He spent a week in hospital on Heparin and is now home on Coumadin.  We've already seen 7 orthopedists who have given us two different schools of thought:

1)  emergency surgery to repair the LCL/avulsion fracture (open lateral incision) which must be done within the first two weeks to avoid allograft.  Obviously too late now, because the whole thing became complicated by DVT which would have required an IVC filter and stopping the Coumadin to do the surgery.  Later surgery to repair the ACL and perhaps leave the PCL alone.

2)   wait on all the surgeries and let the edema/internal bleeding abate, DVT resolve, come off coumadin, rehab with PT to strenghten muscles for better Post-op recovery.

A further complication was noted by the final OS we liked the best who sent us for EMG and nerve conduction studies to a Neurologist.  There seems to be extensive peroneal nerve damage.  This is actually the worst part for my husband.  The knee causes him NO pain.  All the pain is lateral calf and foot/toes.  He is in soooo much pain and can't sleep.  Neurontin, Percocet...nothing helps.

Any advice on any of the above...?????

Sorry so long   :'(
« Last Edit: December 27, 2009, 07:02:51 PM by newpatient »

Offline newpatient

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I am sorry to respond to my own post, but I'm concerned about possible delayed compartment syndrome (don't know if there's something between acute and chronic). 

My concern is that 4 weeks post injury his foot swells (and gets purplish) whenever it's dependent.  He has terrible nerve pain which he's been told is a result of peroneal nerve damage (proven on EMG) from the trauma.  I'm afraid that the coumadin (for the DVT) is causing possible residual bleeding and perhaps that's causing the foot to swell and perhaps contributing to the nerve pain (from compression). 

Also, no one ever took an MRI of the calf...only of his knee.  Perhaps there was a tear to the peroneus/soleal muscle??  Could that be bleeding from the coumadin?  His calf isn't really tense, only painful.  Just the foot gets tense when it's dependent.

I e-mailed the neurologist my fears and he said to go to a local ER....I paged the vascular sx treating the DVT and he asked if there were pulses (yes, and the foot is not cold) and he said just elevate it! 

I'm sort of at a loss.  Do I just keep waiting or rush back to the ER???


Offline newpatient

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I haven't gotten any responses to this posting, so perhaps I've posted the thread in the wrong section??

In any case, we went yesterday to the vascular surgeon who assured us that it's definitely not compartment syndrome.   He just said to keep it elevated above his heart.  (not sure how long we'll be able to keep this up - it's already been 5 weeks post accident!!!)

An interesting note, the CPK blood test that he recommended we get showed double the normal value!!  That means that there is/was definite muscle damage!  No one had addressed that issue up until now!  He said to follow up that issue with the OS. 

Now, in addition to a bone fracture, three torn ligaments, a DVT and nerve damage there's muscle damage...  Not sure when this saga will resolve.

Offline clarky_vl

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Hi,
Sorry to hear of your husbands injury, it sounds much more severe than most and involving many parts of the knee, perhaps why people haven't responded? There are a number of sections on this site, many of which would be relevant to you I think. For example, the cruciates section, meniscus, bone breaks around the knee, I think there is also one for DVT. Maybe asking on these sections questions specific to individual parts of the knee/injury rather than all as a whole might give you more luck with trying to get information? There are a number of people around who have had one or more of your husbands injuries and all willing to help in any way they can, unfortunately there are few who have had all of this!

Sorry to hear of the muscle damage in addition to everythng else. Recovery must seem so far away from you right now, but it will get better. I hope the new year brings your husband good luck with his recovery!

Vicky
11/10/07 ACLr-hamstring, lat meniscectomy, microfracture
29/7/08 ACL revision-hamstring/LARS
7/7/09 ACL revision-quad/LARS
20/2/10 Screws out, bone grafts, arthroscopy.
6/7/10 ACL revision-BPTB allograft
14/3/11 Screws out, bone grafts, arthroscopy.
Then: ACL revision + extra-articular repair















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