Welcome to the Emergency Medicine Cases podcast.

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine from EMC Studios in Toronto.

If you see that foot drop with a buckling knee injury, you should consider that perhaps they had a dislocated knee.

If you don't pick it up within the first six to eighth hours, you're pretty doomed.

So the same mechanism in different ages can lead to totally different injuries.

A straight leg raises neither 100% sensitive nor specific.

That is gross instability. You won't miss it.

And maybe the test they need is a needle in the knee as opposed to an x-ray of the knee.

And I think our mindset has to change.

I used to take a very simplistic approach to knee injuries in the ED.

If it's broken or dislocated, reduce, immobilize, and refer.

And if it's not broken, assume that it's a soft tissue injury, instruct the patient

with the rice mnemonic, maybe apply a splint, maybe give them some crutches, and have them

check in with their family doctor in a few days. It was very unsatisfying not to really have a solid

understanding of the specific knee injuries that I should be looking out for and just lumping every knee injury with a normal x-ray into the soft tissue injury basket.

I didn't feel that I was taking good care of these patients, and actually, I wasn't.

And for me, that just wasn't good enough.

You see, there's a whole slew of very important occult knee injuries,

those that have a normal or near-normal X-ray that can cause serious morbidity if you miss them.

And for the catch-all soft tissue injuries, there's some subtleties in diagnosis and management

that'll make a real difference to our patients. So to help us pick up those tough

occult injuries, hone our diagnostic skills, and do better for our knee-injured patients,

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