Fracture Dislocation of the Knee - A Staged Approach for Bony and Ligamentous injuries or All-at-Once Surgery?

Abstract

HISTORY - 45yo male sustained a closed right knee injury after crashing his all-terrain vehicle. In the emergency department, his examination showed and isolated deformity to his right knee. He had intact motor nerve function to the right leg but complained of numbness to the distribution of the common peroneal nerve. He had strong peripheral pulses with an ABI 1.0. X-rays and CT (Figure 1, Figure 2) revealed a comminuted displaced anteromedial tibial plateau fracture, altered tibiofemoral alignment with posteromedial tibia subluxation and a fibular head fracture. MRI examination (Figure 3) added the presence of a medial meniscal root detachment and PCL rupture. Figure 2Coronal, sagittal and axial CT imaging demonstrating a comminuted displaced anteromedial tibial plateau fracture with posterior subluxation of the tibia View Large Image Figure Viewer Download Hi-res image Figure 3A. Coronal images of the right knee demonstrating a medial meniscal root tear/detachment with displacement (white arrow), a fibular head fracture with intact biceps, LCL, peroneal fascia (bent arrow). B. Rupture of femoral sided PCL with posterior tibial subluxation (white arrow). C. Lateral compartment posterior tibial subluxation with tenting of the popliteal tendon. View Large Image Figure Viewer Download Hi-res image