Immediate life-saving interventions
› Immediate stabilization triggers
› If suspected knee dislocation, immediate reduction if deformity present and limb threatened
› Post-reduction neurovascular reassessment
› Post-reduction immobilization in long leg splint
› Vascular evaluation pathway regardless of symptom improvement
› If pulseless or ischemic limb, immediate vascular and ortho escalation
› If open joint suspected, antibiotics and urgent ortho pathway
Immobilization and Splinting
› Brace and immobilization strategy
› Knee immobilizer for gross instability
› Short-term use
› Transition to hinged brace when safe
› Hinged knee brace for collateral ligament injuries
› Valgus or varus protection
› Crutches and weight-bearing plan
› Weight-bearing as tolerated for stable sprains
› Partial or non-weight-bearing for significant instability or fracture concern
› Immobilization principles
› Avoid prolonged total immobilization when not required
› Early rehab emphasis in soft tissue knee injuries :contentReference[oaicite:7]{index=7}
› Elevation and compression for swelling
› Re-check neurovascular status after bracing
› Reduction pathways
› Knee dislocation reduction principles
› Gentle traction and reversal of deforming force
› Avoid repeated forceful attempts
› Immediate reassessment of pulses and motor
› Patellar dislocation reduction principles
› Extension with medial pressure
› Post-reduction stability and effusion reassessment
› Analgesia and anesthesia options
› Multimodal pain control ladder
› Acetaminophen
› 1000 mg PO every 6 to 8 hours
› Maximum 4000 mg per 24 hours
› Ibuprofen
› 400 to 600 mg PO every 6 to 8 hours
› Maximum 2400 mg per 24 hours
› Naproxen
› 250 to 500 mg PO every 12 hours
› Opioid for breakthrough pain
› Hydromorphone
› 1 to 2 mg PO every 4 to 6 hours as needed
› Avoid with concurrent sedatives when possible
› Oxycodone
› 5 mg PO every 4 to 6 hours as needed
› Procedural sedation when reduction required
› Airway readiness and monitoring
› Continuous pulse oximetry
› Capnography when available
› Titrated sedative dosing to effect
Open fracture medications and timing
› Open injury pathway when suspected
› Antibiotics as early as feasible
› Cefazolin IV
› 2 g every 8 hours
› 3 g every 8 hours if weight 120 kg or more
› If severe beta-lactam allergy
› Clindamycin IV
› 900 mg every 8 hours
› Tetanus prophylaxis based on immunization status
› Sterile dressing and splint
› Urgent orthopedics consultation and transfer triggers
DVT prophylaxis when relevant
› VTE risk considerations
› Lower limb immobilization
› Limited mobility
› Prior VTE
› Malignancy
› Pregnancy or postpartum
› Prophylaxis alignment with local protocol
› If high risk and prolonged immobilization, specialist or institutional pathway
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