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Immediate threats and triggers
Initial triage priorities
High-energy mechanism
Motor vehicle collision
Fall from height
Gross deformity
Suspected dislocation
Suspected fracture
Open wound near joint
Possible open fracture
Possible traumatic arthrotomy
Neurovascular compromise
Absent or diminished distal pulses
Progressive neurologic deficit
Compartment syndrome concern
Pain out of proportion
Pain with passive stretch
Systemic toxicity
Fever
Hypotension
Focused stabilization and monitoring
Stabilization targets
Analgesia adequate for exam
Multimodal strategy preferred
Avoid oversedation before stability assessment
Temporary immobilization
Knee immobilizer for gross instability
Posterior splint if severe pain or fracture concern
Weight-bearing status
Non-weight-bearing if instability or fracture not excluded
Protected weight-bearing if stable and fracture excluded
Neurovascular reassessment
After immobilization
After any reduction attempt
Neurovascular and limb-threatening evaluation
Neurovascular screen
Vascular status
Dorsalis pedis pulse
Posterior tibial pulse
Capillary refill
Skin temperature and color
Motor function
Ankle dorsiflexion strength
Great toe extension strength
Ankle plantarflexion strength
Sensory function
Dorsum of foot sensation
Plantar foot sensation
Lateral leg sensation
Knee dislocation risk pathway
Popliteal artery injury concern
ABI < 0.9 then urgent vascular imaging
Hard signs then immediate vascular surgery involvement
Peroneal nerve injury concern
Foot drop
Dorsal foot numbness
Pain control strategy
Analgesia plan
Non-opioid first-line
Acetaminophen oral 15 mg/kg (max 1,000 mg per dose)
Ibuprofen oral 10 mg/kg (max 600 mg per dose)
Topical option
Diclofenac gel for localized pain
Avoid on broken skin
Opioid rescue for severe pain
Oxycodone oral 0.05 to 0.1 mg/kg (max 5 mg per dose) short course only
Avoid with respiratory depression risk
PEARLS
Key principles
Septic arthritis until excluded when hot swollen knee with fever
Rapid joint destruction risk
Early ortho involvement when suspected
Extensor mechanism rupture as time-sensitive diagnosis
Inability to straight-leg raise
Requires urgent orthopedic evaluation
Knee dislocation may reduce spontaneously
History of gross deformity
Mandatory vascular assessment
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.