A case report of neglected patellar dislocation with postoperative complication of thyroid storm mimicking infection - A double whammy

Singhi, Prahalad Kumar; Raju, Sivakumar; RaghavaKumar, V.P.; Somashekar, V

doi:10.1016/j.jajs.2020.09.003

Cited by 1 publication

(3 citation statements)

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“…A neglected dislocation, however, presents additional problems as there is a lot of fibrosis which needs to be carefully removed, avoiding injury to the chondral surface. As has been observed by other authors [2,6,7] and also seen in our case, a lot of releases are required before the patella can be mobilized and relocated back into the trochlear groove. This may lead to soft tissue healing problems, as was seen in our case and also the case reported by Singhi et al [7].…”

Section: Discussionsupporting

confidence: 81%

“…As has been observed by other authors [2,6,7] and also seen in our case, a lot of releases are required before the patella can be mobilized and relocated back into the trochlear groove. This may lead to soft tissue healing problems, as was seen in our case and also the case reported by Singhi et al [7]. Our patient had an osteochondral fracture of the medial patellar margin which has also been reported by ElMaraghy et al and Hackl et al [4,9] Once the patella is relocated, medial retinacular structures need to be repaired meticulously to prevent re-dislocation.…”

Section: Discussionsupporting

confidence: 81%

“…Postoperatively patient developed a thyroid storm which settled with medical management. The patient also had delayed wound healing [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Neglected Locked Patellar Dislocation in an Adult Female: Report of a Rare Case

Chaudhary¹,

Gandhi²,

Koichade³

et al. 2021

JOCR

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Introduction: Dislocation of patella is a very common injury which usually reduces spontaneously or can be reduced easily using gentle manipulation. Irreducible patellar dislocations are rare and usually result due to either rotation of patella along the horizontal or vertical axis or due to bony impaction. Neglected locked patellar dislocations are extremely rare injuries presenting additional challenges. Case Report: We are reporting a case of a 24-year female who presented to us 4 months after suffering a knee injury for which she received native treatment initially. On presentation, patient was able to walk with a limp and some discomfort but was unable to squat or sit cross-legged. Clinical examination revealed a patellar dislocation which was irreducible. On open reduction, the patella was found to be locked in the lateral gutter with rotation along its vertical axis and with an osteochondral fracture of its medial margin. There were a lot of fibrotic adhesions which required extensive release, following which the patella could be derotated and reduced into the trochlear groove. The medial retinaculum was repaired using transosseous sutures. Postoperatively, the patient developed wound edge necrosis which was managed with debridement and secondary suturing. At 1-year follow-up patient had almost full knee range of motion without any signs of patellar pain or instability and was able to squat and sit cross-legged. Conclusion: Unlike acute irreducible patellar dislocations which can be managed easily with open reduction, a neglected dislocation necessitates wider surgical exposure and a lot of soft tissue releases, which may jeopardize vascularity of the soft tissues leading to wound healing problems. Release of all adhesions while taking care to prevent further chondral injury, adequate lateral retinacular release, derotation of patella to relocate it into trochlear groove, and meticulous medial retinacular repair is essential for a successful outcome. Keywords

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