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Fell down on knee after operation of RTA. Swelling appeared. MRI and x-ray done. Is there any serious problem?

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Orthopaedic Surgeon
Practicing since : 2000
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I had a RTA 10 yrs ago in which one the injuries I sustained was closed XXXXXXX degloving injury to my right thigh, I was operated on successfully and had no further problems. 10 weeks ago however, I sustained a serious fall to my right knee, upon investigations I had a suspected MCL sprain. MRI and X-ray results showed dramatic subcutaneous edema throughout knee joint and popliteal fossa and muscle belly, no fractures or tears visible. 4 weeks ago and literally overnight I developed enormous "free swelling" that moves with gravity on my right thigh, accompanied by acute numbness and severe pain at the sight of the original scar. I also have severe pain with compression to the thigh and am unable to bear lying on my side. I have been tested on ultrasound both for DVT and a pelvic/ abdominal, blood tests, X-rays, all clear. Could the degloving occur again as a result of the recent leg trauma? And if yes, which is the best imaging to find the problem?

I am a heavy person, but I know there's something wrong with my thigh - it is 9cm larger than the left despite having tried all avenues to reduce swelling, and has been ongoing for a month. Any advice please.

Posted Sat, 18 Aug 2012 in Back Pain
Answered by Dr. Atul Wankhede 13 hours later
Thanks for posting your query.

The MRI, I believe is most evident amongst all the investigations performed. And its a good news if it says there is no fracture or tear. The fluid though seems to be the only factor thats creating the symptoms. Well I'm not sure what you mean by closed XXXXXXX degloving injury, since in general, degloving injury explains the loss of skin in circumferential fashion over a part of limb.

Nevertheless, the fact that you have evidence of free fluid in your joint and other dependent area besides knee joint, and that it moves with gravity warrants further investigation and treatment. The fluid needs to evaluated in nature of amount, composition (blood/pus/synovial fluid?) and biochemistry. It may be tapped in asceptic precautions and sent for microbiology if infection is suspected.

In my opinion, it is possible to have extracellular fluid accumulation post trauma and since you had an old injury there must be a dead space (dependent area) that allowed that fluid to accumulate. The best imaging is MRI, and I would stand besides it if they rule out fractures/tears.

To tap (and not completely drain) the fluid is the only way we will find out its composition. If the fluid is pathological, we might need to drain it completely. Ask your physician for medicines that help reduce the swelling(like seratiopeptidases,trypsin-chymotripsin,anti-inflammatory), use a crepe bandage and try hot/cold fomentation.

I hope this answers your question. For any further queries, I'm available for follow up.
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