A Posteromedial Approach to a Complex Multifragmentary Avulsion Fracture of the Posterior Cruciate Ligament: A Case Report
Journal Title: Journal of Orthopedics & Rheumatology - Year 2014, Vol 1, Issue 3
Abstract
While riding a motorcycle, a 37-year-old male injured his knee in a collision with a vehicle. The injury occurred when the patient’s motorcycle landed on top of him. The exact location of impact is unknown. The patient complained solely of pain in his right, lower extremity. Pre-operative clinical examination revealed no neurovascular deficit, but was limited due to significant pain and patient reluctance to participate in range of motion. Radiographs showed an intraarticular fracture of the posterior aspect of the right tibial spine with the dominant fragment displaced approximately 1 cm posteriorly in the joint space. Computed Tomography (CT) verified a 1 cm fragment lateral to the posterior tibial plateau (Figure 1). Magnetic Resonance Imaging (MRI) of the knee showed a comminuted fracture involving the tibial plateau as seen on radiographs and CT, an attenuated Anterior Cruciate Ligament (ACL) without a full thickness tear, and an intact Posterior Cruciate Ligament (PCL) attached to the dominant posteriorly displaced fracture fragment (Figure 2). Other ligament pathology included a type I sprain of the fibular collateral ligament (FCL). Examination under anesthesia revealed restricted motion of the knee from 0 to 90 degrees, posterior sag was apparent and posterior drawer test with the knee flexed at 90 degrees showed grade III instability with a soft endpoint. The patient also had a slight increase in dial testing at 30 degrees and varus stress testing at 30 degrees demonstrated a slight laxity with firm endpoint. Based on the patient’s age and activity level, operative intervention was deemed appropriate.
Authors and Affiliations
Bashir Zikria
Keywords
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- EP ID EP208536
- DOI 10.13188/2334-2846.1000011
- Views 111
- Downloads 0
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