Rim plating for a rare variant of posteromedial tibial condyle fracture; partial coronal split, akin to Hoffa's fracture, associated with multi-ligament injuries and central depression

Abstract

Introduction: Proximal tibia intra-articular fractures are commonly associated with ligamentous injuries and require early diagnosis and intervention. An array of fracture patterns can be encountered, and Schatzker's classification is a standard description to identify them. However, several patterns have been described that fall outside the ambits of this classification. We present a rare fracture pattern of partial posteromedial condyle coronal split associated with depression of the anterolateral plateau and mid substance tear of medial collateral ligament (MCL) and avulsions of anterior and posterior cruciate ligaments(ACL/PCL).

Case: A 45 year old male presented with swelling and severe pain in his right knee after an accident. He was diagnosed with a posteromedial tibial condyle coronal split with two fragments, along with multi-ligament injuries. He was operated with cannulated screws and a rim plate for the larger fragment. The fractures united and patient was doing well in his daily activities at final follow up of 15 months.

Conclusion: Proximal tibia fractures can present as an array of fracture patterns and require prompt diagnosis and surgical management. The one described in the present case is a rarest of rare pattern and rim plating could be a cheaper alternative to the anatomical plates.

Keywords: Hoffa's; Multi-ligamentous injury; Posteromedial coronal split; Proximal tibia; Rim plating.

Fig. 1

Lateral radiograph showing a large posterior condylar fragment.

Fig. 2

Seemingly normal looking anteroposterior radiograph of the knee.

Fig. 3

CT images showing partial coronal split of the posteromedial tibial condyle.

Fig. 4

CT images showing partial coronal split of the posteromedial tibial condyle.

Fig. 5

CT scan showing avulsion of the anterior cruciate ligament.

Fig. 6

Intra-operative clinical image showing the technique of rim plating for the posteromedial fragment.

Fig. 7

Intra-operative C arm image showing method to elevate the depressed fragment.

Fig. 8

Post-operative radiographs showing the rim plating and fixation of the posteromedial fragments.

Fig. 9

Post-operative radiographs showing the rim plating and fixation of the posteromedial fragments.

Fig. 10

At 15 months of follow up, patient showed functional range of knee movements.

Fig. 11

Plain radiographs at 15 months of follow-up, showed union of the posteromedial fragments.

Fig. 12

Plain radiographs at 15 months of follow-up, showed union of the posteromedial fragments.