Aim:
This paper presents the “journey” of managing a multi-ligamentous knee injury after a knee dislocation in a 2m10cm (6’ 11”,) 386 kg (850 lb) still ambulatory adult male and the problems encountered and the lessons learned in this unique case.
Methods:
A 2m 10cm 386 kg male presented after having to be extracted from his house by the fire department have stumbled getting out of the shower and dislocating his left knee.
His care acutely and subsequently documents the unique challenges in the acute care, initial and subsequent investigation an early surgical stabilisation and later reconstruction procedures.
Strategies in facilitating weight loss were essential in being able to eventually manage this condition to allow a successful outcome after over three years of interventions and rehabilitation to allow a successful and life changing result for the patient.
Results:
The patient was initially managed on two operating tables with challenges with external fixation with leg control and pin length.
MRI imaging was not possible due to the size of the patient and US scan was of limited value.
Modifications to arthroscopic assessment and surgery required some innovative adaptations.
Post operative control, splintage and walking aids were a major problem as mobilisation within 8 weeks was seen as essential to reduce the risk of the patient becoming permanently bed bound.
Several revision procedures were required and eventually collaboration with an arthroplasty/tumour colleague allowed successful stabilisation and mobilisation.
Weight loss strategies and making contracts with the patient regarding weight loss were an essential part of the management of this patient resulting in significant weight loss that made successful surgery possible.
Conclusion:
A summary of managing a knee dislocation in an extreme sized patient highlights the unique problems encountered and some of the solutions. Hopefully this will provide some strategies for others who may encounter a similar problem.
