Bilateral Knee Dislocation in an Elderly Patient: From Vascular Emergency to Functional Recovery

Traumatic knee dislocations are rare but serious injuries associated with limb-threatening vascular compromise and a frequently poor functional prognosis. We report the case of a 70-year-old man with known dementia who sustained a high-energy road traffic accident resulting in bilateral knee dislocation. On admission, he was hemodynamically stable with preserved and symmetrical distal peripheral pulses. Initial radiographs confirmed bilateral dislocation, and computed tomography angiography of the lower limbs showed no arterial injury, particularly of the popliteal arteries. After pre-anesthetic assessment, bilateral closed reduction was performed under spinal anesthesia, followed by stabilization with trans-tibio-femoral screws within a multidisciplinary management pathway. The postoperative course was characterized by appropriate multimodal analgesia, early mobilization and physiotherapy, and pharmacologic thromboprophylaxis, allowing satisfactory functional recovery without vascular or neurologic complications. This case highlights the need for anesthesiologist-intensivists to balance the risk of vascular emergency, geriatric frailty, and the goals of rapid functional recovery.