Dislocation of the patella usually occurs from a twisting injury on the extended knee and is more common in women. The patella is displaced laterally over the lateral condyle, resulting in pain and deformity of the knee (Fig 2.66.-10.). Tearing of the medial knee joint capsule often occurs. Reduction is accomplished following conscious sedation by flexing the hip, hyperextending the knee, and sliding the patella back into place. This results in immediate relief of pain, but further soreness from capsular injury persists for a period of time. The patella and knee should be x-rayed to rule out a fracture, and the knee should be immobilized after reduction. Follow-up with a primary care provider or orthopedist within one to two weeks is suggested. Partial weight-bearing progressing to full weight-bearing, nonsteroidal anti-inflammatory agents, and isometric quadriceps strengthening exercises are also indicated. Recurrent lateral dislocation of the patella occurs in about 15 percent of patients, and superior, horizontal, and intercondylar dislocations require referral to an orthopedic surgeon for possible surgical intervention.
FIG. 266-10. Lateral dislocation of the patella. (From Lyman JI, Ervin ME. Management of common dislocations, in Roberts JR, Hedges JR (eds). Clinical Procedures in Emergency Medicine. Philadelphia, WB Saunders, 1985, p 634. Used with permission.)
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