Dropping Like a Rock

"Hey, I think I can send this guy home with a knee immobilizer, crutches, and ortho follow-up. He hurt his knee when he fell during an altercation. I don't see a fracture on the x-ray. Can I get him out of here?" asked the resident as he documented the x-ray reading.Glancing at the images, I replied, "Let me look at him because that doesn't look quite right."The patient was lying in a bed with shorts on, so I could already assess that the knee overall looked relatively normal. No significant effusion, abrasions, or obvious deformity were present.I asked him to lift his leg off the bed, but he refused. I put my hand two inches above his toe challenging him to try just that far. The leg remained on the stretcher. Next, I lifted his leg with my right hand under the thigh and my left hand under his lower leg. I removed my left hand, and his foot dropped like a rock.Palpation inferior to the patella toward the tibial tuberosity confirmed my diagnosis. My fingers seems to fall into a hole coming off the lower end of the kneecap. He had a patellar tendon rupture.Coming back to the resident, I asked what he thought about the patella. Was it high-riding? How could he tell?Certainly, this wasn't the best lateral. Still, the patella usually articulates directly in front of the condyle, and the distance of the patellar tendon is usually about the same distance as the vertical length of the patella. It was almost twice that far in our patient. A patellar tendon rupture...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs