Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2022

Open Access 01-12-2022 | Knee Dislocation | Case report

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

Authors: Farzad Vosoughi, Fardis Vosoughi, Seyed Hadi Kalantar

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Login to get access

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 1st 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.
Literature
1.
Malik SS, MacDonald PB. The Irreducible Knee Dislocation. J Knee Surg. 2020;33(4):328–34.CrossRef
2.
Durakbaşa MO, Ulkü K, Ermiş MN. Irreducible open posterolateral knee dislocation due to medial meniscus interposition. Acta Orthop Traumatol Turc. 2011;45(5):382–6.PubMed
3.
Manske RC, Hosseinzadeh P, Giangarra CE. Multiple ligament knee injury: complications. N Am J Sports Phys Ther. 2008;3(4):226–33.PubMedPubMedCentral
4.
Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977;59(2):236–9.CrossRef
5.
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium—2018. J Orthop Trauma. 2018;32:S1–10.CrossRef
6.
Huang G, Zhang M, Zhang Y, Wang X, Zhang M, Liu G. Hoffa fracture combined with rotational dislocation of the knee joint: A novel case report. Med (Baltimore). 2021;100(14):e25253.CrossRef
7.
Calderazzi F, Visigalli A, Scita G, Spirito A, Ferrari U, Ceccarelli F, Pogliacomi F. Open fracture-dislocation of the knee associated with nonunion of the medial femoral condyle and chronic tendon patellar rupture. Acta Biomed. 2021;92(S3):e2021013.PubMedPubMedCentral
8.
Schenck RC Jr, McGanity PL, Heckman JD. Femoral-sided fracture-dislocation of the knee. J Orthop Trauma. 1997;11(6):416–21.CrossRef
9.
Shetty GM, Wang JH, Kim SK, Park JH, Park JW, Kim JG, Ahn JH. Incarcerated patellar tendon in Hoffa fracture: an unusual cause of irreducible knee dislocation. Knee Surg Sports Traumatol Arthrosc. 2008;16(4):378–81.CrossRef
10.
Shah Faaiz Ali, Ali Main Amjad, Qureshi Abdur Rehman, Naeemullah, Khan Umar Zia, Sarwar. KM: A Rare Variant of Acute open Fracture Dislocation of Knee Joint- A Case Report. JIMDC 2018, 7(1):78–82.
11.
Durakbasa MO, Kose O, Ermis MN, Demirtas A, Gunday S, Islam C. Measurement of lateral plateau depression and lateral plateau widening in a Schatzker type II fracture can predict a lateral meniscal injury. Knee Surg Sports Traumatol Arthrosc. 2013;21(9):2141–6.CrossRef
12.
Green RN, Pullagura MK, Holland JP. Irreducible fracture-dislocation of the knee. Acta Orthop Traumatol Turc. 2014;48(3):363–6.CrossRef
13.
Gümbel D, Matthes G, Napp M, Lange J, Hinz P, Spitzmüller R, Ekkernkamp A. Current management of open fractures: results from an online survey. Arch Orthop Trauma Surg. 2016;136(12):1663–72.CrossRef
14.
Bhandari M, Jeray KJ, Petrisor BA, Devereaux PJ, Heels-Ansdell D, Schemitsch EH, Anglen J, Della Rocca GJ, Jones C, Kreder H, et al. A Trial of Wound Irrigation in the Initial Management of Open Fracture Wounds. N Engl J Med. 2015;373(27):2629–41.CrossRef
15.
16.
Blachut PA, Meek R. O’brien P: External fixation and delayed intramedullary nailing of open fractures of the tibial shaft. Sequential Protoc JBJS. 1990;72(5):729–35.
17.
McGraw J, Lim E. Treatment of open tibial-shaft fractures. External fixation and secondary intramedullary nailing. J Bone Joint Surg Am Vol. 1988;70(6):900–11.CrossRef
18.
Fischer MD, Gustilo RB, Varecka T. The timing of flap coverage, bone-grafting, and intramedullary nailing in patients who have a fracture of the tibial shaft with extensive soft-tissue injury. J Bone Joint Surg Am. 1991;73(9):1316–22.CrossRef
19.
Nowotarski PJ, Turen CH, Brumback RJ, Scarboro JM. Conversion of external fixation to intramedullary nailing for fractures of the shaft of the femur in multiply injured patients. JBJS. 2000;82(6):781.CrossRef
20.
Elniel AR, Giannoudis PV. Open fractures of the lower extremity: Current management and clinical outcomes. EFORT Open Rev. 2018;3(5):316–25.CrossRef
21.
Kugelman DN, Qatu AM, Strauss EJ, Konda SR, Egol KA. Knee Stiffness After Tibial Plateau Fractures: Predictors and Outcomes (OTA-41). J Orthop Trauma. 2018;32(11):e421–7.CrossRef
Metadata
Title
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
Authors
Farzad Vosoughi
Fardis Vosoughi
Seyed Hadi Kalantar
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-022-05268-y

Other articles of this Issue 1/2022

BMC Musculoskeletal Disorders 1/2022 Go to the issue

Research

The characteristics and treatment strategy for transolecranon fracture-dislocation of the elbow in children: a retrospective study

Research

Factor affecting the discrepancy in the coronal alignment of the lower limb between the standing and supine radiographs

Research

Unmatched rod contouring at the proximal end predisposes to occurrence of junctional kyphosis in early-onset scoliosis patients undergoing traditional growing rods treatment

Research

Determinants of complex regional pain syndrome type I in patients with scaphoid waist fracture- a multicenter prospective observational study

Research

Comparison of open reduction and fixation with hook plate and modified closed reduction and fixation with tightrope loop plate for treatment of rockwood type III acromioclavicular joint dislocation

Research

Correlation and comparison of quadriceps endurance and knee joint position sense in individuals with and without unilateral knee osteoarthritis