Delayed treatment of neglected open knee dislocation; case report

Abstract

Introduction and importance: Traumatic open knee dislocation is a rare, severe injury characterized by severe ligamentous destruction and a high frequency of infection and neurovascular involvement. Delayed treatment of these injuries is complicated, necessitating the intervention of not only a skilled orthopedic surgeon but also a plastic surgeon. To the best of our knowledge, this is the first case of delayed open knee dislocation faced by a practicing surgeon in an underdeveloped country (Somalia) with a successful outcome.

Case presentation: A 60 years old diabetic man, presented to our emergency unit with an open wound of his left knee, due to a traffic accident three months ago. At the time, a bone healer reduced the dislocation and applied traditional medicine to cover the wound. We decided to treat the patient with vigorous debridement, gastrocnemius flap, and hybrid external fixation for arthrodesis. The patient was followed up for three months after the surgery with excellent clinical and radiological outcomes.

Conclusion: Although treating delayed open knee dislocation injuries is challenging, using a gastrocnemius muscle flap to cover the knee joint and arthrodesis to stabilize the joint will not only prevent limb amputation but will also result in satisfactory results.

Keywords: Arthrodesis; Delayed treatment; Gastrocnemius flap; Open knee dislocation; Somalia.

Fig. 1

Preoperative clinical pictures and radiographs of the knee demonstrates reduced but severely infected anterior wound of the knee.

Fig. 2

Intraoperative clinical image of the knee joint indicates instability, knee cartilage erosion, severely damaged joint ligaments, and a torn patellar tendon.

Fig. 3

Intraoperative medial gastrocnemius flap elevated and transposed to reconstruct the defect. Full thickness skin graft used to cover muscular belly. Anteroposterior and lateral radiographs showing reduction of the joint and fixation with hybrid external fixator augmented by two crossed Steinmann pins.

Fig. 4

Three months clinical and radiographs follow-up of the knee showing good alignment and excellent healing of the flap without any signs of infection.