Abstract
A 20- year-old female student was involved in a motor vehicle accident. She sustained a severe friction injury to the left knee that resulted in considerable soft tissue and bone loss. There was also damage to the knee extensor mechanism, tibialis anterior muscle, femoral trochlea, the anterior half of the tibial plateau extending distally to the proximal tibia and skin. However, there was no crushing of the limb or resultant neurovascular deficit but cancellous bone and the remainder of the joint were exposed. Repeated surgical debridement was performed and was followed by covering of the soft tissue using a latissimus dorsi free flap and skin grafts. The bony defect was reconstituted with antibiotic bone cement to prevent flap adherence and shrinkage, enhance stability and prevent fracture. The cement was later removed at the time of arthrodesis at which time an ipsilateral double barrel vascularised fibular graft supplemented with autogenously cancellous bone and a ring fixator was used. Computer tomography confirmed union at three months post procedure. The fixator was then removed and a tibialis posterior transfer was performed.
Highlights
Complex soft tissue defects and bone loss of the knee in the presence of a functional foot pose a treatment dilemma
Case reports and retrospective reviews have been published regarding these defects, but most studies are limited by a small number of patients and/or involve cases related to total knee arthroplasty
We report here a case demonstrating management of a young patient involved in a motor vehicle accident who sustained a complex soft tissue injury with bone loss of the knee
Summary
A 20-year-old female was involved in a motor vehicle accident in November 2008 She was a passenger in a motorcar when the driver lost control. Most of her body remained in the car except for her left lower limb, which was dragged along the road surface. As a result, she sustained extensive friction burns and degloving injury of the anterior aspect of the left knee involving loss of her distal quadriceps muscle, the patella, the tibialis anterior muscle, the femoral trochlea and the anterior half of the tibial plateau extending distally to the proximal tibia (Figure 1). She was referred to the senior author and was transferred to our institution on the third day after injury. She underwent further wound debridement in preparation for definitive wound covering
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