Open knee dislocation, triple intra-articular fractures and patellar tendon rupture: case report of a knee disaster treated with aggressive irrigation/debridement, early anatomic reduction and internal fixation

Abstract

Background: Open knee fracture-dislocation is a rare orthopedic injury. However, the importance of its correct management could not be overstated. To the best of our knowledge, this is the fifth study reporting a case with simultaneous Hoffa fracture and knee dislocation and the 1^st study describing a patient with open plateau fracture-dislocation accompanied with Hoffa fracture, patella fracture, and patellar tendon tear. In addition, this report is noticeable as our case had no gross ligament injury unlike frequent association of knee dislocation with knee collateral ligament damage.

Case presentation: In this study, we describe a 34-year-old motorcyclist referred to our center following a motor car accident. Further work-up revealed an open irreducible posterolateral knee dislocation, type 5 Hohl and Moore plateau fracture, lateral femoral condyle Hoffa's fracture, patellar fracture, and patellar tendon tear of his right knee. During an open reduction, it turned out that an entrapped lateral meniscus prevented the joint to be reduced by closed means. After applying a temporary external fixator, the patient was finally managed with open reduction and internal fixation.

Conclusion: Irreducible knee dislocation needs further work up to rule out any interposed soft tissue into the joint. Aggressive irrigation/ debridement, early anatomic reduction, and internal fixation may help reduce open fracture complications including infection, non-union, and stiffness.

Keywords: External fixator; Knee fracture dislocation; Open fracture; Trauma.

Fig. 1

The initial presentation of our patient with an open knee fracture dislocation. He had a knee laceration on the anterolateral side and the distal femur was exposed

Fig. 2

Plain knee X ray demonstrates a posterolateral fracture dislocation

Fig. 3

Computed Tomography revealed a posterolateral knee dislocation accompanied with lateral distal femoral Hoffa fracture, vertical patella fracture and type 5 Hohl and Moore fracture dislocation of the proximal tibia

Fig. 4

The patient’s wound after irrigation/ debridement. The Hoffa fracture was fixed with cancellous screw, the knee was reduced and temporary fixed with external fixator

Fig. 5

In the second look surgery, it was revealed that the lateral meniscus was interposed between proximal tibial fragments

Fig. 6

The final postoperative plain knee X ray of our patient

Fig. 7

Our patient regained his knee range of motion from nearly complete extension to 120 degree flexion

Fig. 8

MRI at the latest follow up: a, anterior cruciate ligament; b,posterior cruciate ligament; c, tensor fascia lata; d, medial collateral ligament; e, fibular collateral ligament