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