SAQ 974 – Orthopaedics – hyperextension knee injury with severe pain after casting

You are asked by nurses to chart analgesia for a patient seen by a colleague on the previous shift, admitted under orthopaedics and ready for the ward.

The notes describe a 42-year-old man with a jet-ski injury: he jumped off a wave, landed heavily, hyperextended the left knee, reported a knee dislocation, and then had deformity and significant pain.

The knee X-rays are shown below.

List four relevant findings on the X-rays.

(Marked out of 4.0)

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Complete the table identifying two potential complications related to this mechanism of injury and how you could assess for each.

(Marked out of 4.0)
</p> <table class="saq-prop-table" style="width: 100%; max-width: 100%; table-layout: fixed; border-collapse: collapse;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Complication</th> <th style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;">Means of assessment</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> <td style="overflow-wrap: anywhere; word-break: normal; white-space: normal; vertical-align: top; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

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A long-leg cast has been applied and the leg elevated. The patient remains in extreme pain despite opioid analgesia. List two possible explanations for the ongoing severe pain.

(Marked out of 2.0)

/ 2

The patient is started on fentanyl PCA and transferred to the ward. The next day he goes to theatre, and the ED director receives a call from the orthopaedic consultant: the POP backslab applied in ED was found to be a circumferential below-knee POP and the patient required fasciotomy for compartment syndrome. An incident notification has been submitted. List four steps involved in managing this incident.

(Marked out of 4.0)

/ 4

Total Score: 0 / 14

Percentage: 0%