Severe Knee Injury After Fall: Symptoms, Diagnosis, and Next Steps

Knee issues

Recently, I fell down the stairs at home with a loud crack, feeling something break.
I couldn't stand up and was in excruciating pain.
After forcing myself to stand, I noticed blood and upon examination, I found that my right knee had sunk in by 1 cm and was bleeding, likely from hitting the edge of the stairs.
After going to the hospital, I discovered that not only did I have a fractured patella, but because I rolled down several steps after the fall, I also sustained a comminuted fracture of the right femur, dislocation, and a fracture of the left tibia.
All ligaments in my right knee were completely torn, with ruptured tendons and meniscus, along with the comminuted fracture.
My left knee was hyperextended and dislocated.
About five minutes later, I started to notice bruising on both legs, totaling 28 bruises, with a large bruise of 1 cm radius on my right knee, accompanied by intense pain.
Subsequently, I began to feel numbness and was unable to move, while my right knee started to turn black and purple.
What should I do?

Niming, 10~19 year old female. Ask Date: 2021/08/10

Dr. Shi Guozheng reply Orthopedics

If you are already receiving treatment at a hospital, you should follow the physician's recommendations, which may include immobilization with a cast or surgery.
A decision can only be made after assessing the clinical condition.

Reply Date: 2021/08/10

More Info

I'm sorry to hear about your severe knee injury and the complications that have arisen from your fall. Based on your description, it sounds like you have sustained multiple serious injuries, including fractures, dislocations, and ligament tears in your knees. Here’s a comprehensive overview of your situation, including symptoms, diagnosis, and recommended next steps.

Symptoms
From your account, the symptoms you are experiencing are quite severe and include:
- Intense pain: This is likely due to the fractures and soft tissue injuries.

- Swelling and bruising: The presence of multiple bruises and significant swelling indicates trauma to the soft tissues and possibly bleeding within the joint.

- Deformity: The description of your knee being "depressed" by 1 cm suggests a possible fracture or dislocation.

- Numbness: This could indicate nerve involvement or severe swelling compressing nearby structures.

Diagnosis
Given the complexity of your injuries, a thorough evaluation is crucial. The following diagnostic steps are typically recommended:
1. Imaging Studies: X-rays are essential to assess the fractures and dislocations. A CT scan or MRI may be necessary to evaluate the extent of soft tissue injuries, including ligament tears and meniscal damage.

2. Physical Examination: A detailed examination by an orthopedic specialist is critical to assess the stability of the knee and the extent of the injuries.

Next Steps
1. Immediate Care: If you haven't already, seek immediate medical attention. Given the severity of your injuries, you may require surgical intervention. This could involve:
- Reduction of dislocations: Realigning the bones in the knee.

- Fixation of fractures: Using plates, screws, or rods to stabilize broken bones.

- Repair of ligaments and tendons: If the ligaments are torn, surgical reconstruction may be necessary.

2. Pain Management: Managing your pain is essential. Discuss with your healthcare provider about appropriate pain relief options, especially if you have allergies to certain medications.

3. Rehabilitation: After initial treatment, physical therapy will be crucial for recovery. A rehabilitation program will help restore range of motion, strength, and function to your knee. This process can take several months, depending on the severity of your injuries.

4. Monitoring for Complications: Watch for signs of complications such as increased swelling, persistent pain, or changes in color in your legs, which could indicate issues like compartment syndrome or deep vein thrombosis (DVT).

5. Follow-Up Care: Regular follow-up appointments with your orthopedic surgeon will be necessary to monitor your healing progress and make adjustments to your treatment plan as needed.

Prevention and Precautions
While you are recovering, it’s important to take precautions to avoid further injury:
- Use assistive devices: Crutches or a knee brace may be necessary to support your knee while it heals.

- Avoid weight-bearing activities: As much as possible, keep weight off the injured leg until cleared by your doctor.

- Follow your rehabilitation plan: Adhering to your physical therapy regimen will be vital for a successful recovery.

Conclusion
In summary, your situation is serious and requires immediate medical attention. The combination of fractures, dislocations, and soft tissue injuries can lead to long-term complications if not treated properly. Make sure to communicate openly with your healthcare team about your symptoms and any concerns you may have during your recovery process. Your health and safety should be the top priority, and with the right treatment and rehabilitation, you can work towards regaining function in your knee.

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