Open Dislocation of the Knee with Draining Urine: A Case Report.

Abstract

Concomitant bladder injury is not an uncommon occurrence with pelvic fractures sustained via blunt trauma. Urine can often pool or collect in the peritoneum or form urinomas in multiple sites. We report a case of a patient who sustained a pelvic ring injury with extraperitoneal bladder rupture and an open dislocation of the knee that drained extravasated urine. Pelvic fractures with bladder injury and urinomas have been reported in the literature1,2; to the best of our knowledge, this is the first case report of urine draining from an open knee wound. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. All patient confidentiality in this report is protected according to the United States Health Insurance Portability and Accountability Act. A twenty-three-year-old man was involved in a single-vehicle motorcycle accident at highway speed in which he struck a tree lying in the roadway. At the scene of the accident, he had a Glasgow Coma Score of 15 with stable vital signs; he was transported to our American College of Surgeons Level-I Trauma Center by helicopter. Initial assessment revealed an open dislocation of the left knee and pelvic fracture on the left side. A Foley catheter was placed, and gross hematuria was revealed. The patient was able to wiggle the toes of the left lower extremity prior to intubation. He was intubated in the trauma bay for pain control and sedation during assessment of the leg wound. The left lower extremity revealed a large laceration that extended from the midanterior part of the thigh distally to the tibial tubercle. The wound lay directly anterior over the knee joint, and the articular surface was visible (Fig. 1). This wound was contaminated with dirt and grass debris. The knee was grossly …