Functional and radiological outcome of PCL avulsion fractures treated operatively
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 12
Abstract
Background: Avulsion fractures of the posterior cruciate ligament (PCL) are uncommon. Chronic instability and early degenerative changes will develop as a result of delayed diagnosis. This study were undertaken to study the result of avulsion fracture of PCL injury treated with open reduction and fixation. Objectives :This study were designed to see the result of avulsion fracture PCL treated with CC screw fixation using posteriomedial approach. Materials and Methods: A total of 35 patients undergoing treatment for PCL avulsion fracture treated with posteromedial approach from year 2017 at MGM medical college and hospital Kamothe were selected in which we selected 30 with isolated PCL avulsion fracture who came for regular follow up. Results: Preoperatively patients had severe instability but after 6 weeks postoperatively not a single patients was found to have severe instability. According to Lysholm score , in this study 14(46.66%) patients showed excellent result, 9 (30%) showed good result and 7 (23.33%) showed fair result. Conclusion: Avulsion fracture of PCL injury fixed with partially threaded CC screw with minimal soft tissue damage using posteriomedial approach give good to excellent result. Introduction Avulsion fractures of the posterior cruciate ligament (PCL) are uncommon. A few mechanisms of PCL injuries have been proposed on the basis of the site of injury of the PCL [1]. The foremost common mechanism of avulsion fractures of the PCL at the tibial insertion is a dashboard injury, during which the knee is in a flexed position, and a posteriorly directed force is applied to the pretibial area [1]. The posterior cruciate ligament plays a signicant role in knee stabilization.[2] various harmful effects of PCL injuries have been recognized and reportable.[3] Unlike PCL ligamentous tears, PCL avulsion fractures can be anatomically reduced and rigidly fixed, and the prognosis is far more favorable. Chronic instability and early degenerative changes will develop as a result of delayed diagnosis. Analysis of the PCL is notoriously difficult, both clinically and arthroscopically. Isolated PCL disruption most commonly happen as avulsion at its tibial insertion as opposed to its femoral origin or as a midsubstance tear. On imaging, this injury seems as focal separtion of the posterior tibial articular surface. The mechanisms of injury of the PCL are multiple and include a direct blow to the anterior tibia with the knee flexed (as happen with dashboard injury during a motorized vehicle collision) or severe hyperextension (which normally occurs in the setting of athletic trauma). Despite the actual fact that injury to the PCL could be an isolated finding, concurrent damage to the other major stabilizing structures of the knee is common. This is often signicicantly true when the mechanism of injury involves severe rotational forces [4]. The PCL plays a significant role in knee stabilization [5]. Isolated tear or avulsion of the PCL can be caused by a fall on a flexed knee or by striking of the flexed tibia on the dashboard in a motor vehicle accident [6]. Objective To assess functional and radiological outcome of PCL avulsion fracture treated operatively. Materials and methods A total of 35 patients undergoing treatment for PCL avulsion fracture treated with posteromedial approach from year 2017 at MGM medical college and hospital Kamothe were selected in which we selected 30 with isolated PCL avulsion fracture who came for regular follow up. Inclusion criteria 1. PCL avulsion fractures from tibial insertion. 2. Fresh fractures 3. Age 15-50 year Exclusion criteria 1. Compound fractures 2.Associated other ligament injury 3. Patient treated conservatively Contact details of these patients were retrieved from the in patients records. All patients were then contacted by phone and asked to come for follow up in opd. 30 patients had a minimum of 6 month follow up and were included in our study. At follow up, consent was obtained from the patients and a detailed clinical examination was done by followed by specific functional scores.
Authors and Affiliations
Dr Ankit Agrawal
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