scholarly journals Knee Dislocation with Ipsilateral Tibial Fracture Treated with an Intramedullary Locked Nail and Simultaneous Transtibial Tunnel Knee Ligament Reconstruction: A Case Report of Autografts and Limited Resources

2020 ◽  
Vol 06 (03) ◽  
pp. e160-e163
Author(s):  
Túlio Vinícius de Oliveira Campos ◽  
Marcelo Nacif Moraes ◽  
Marco Antônio Percope de Andrade ◽  
Robert C. Schenck ◽  
Simon T. Donell
Keyword(s):  
Ligament Reconstruction ◽  
Tibial Fracture ◽  
Trauma Surgery ◽  
Knee Dislocation ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Ligamentous Reconstruction

AbstractKnee dislocations associated with ipsilateral tibial shaft fracture represent one of the most challenging injuries in trauma surgery. This injury occurs in only 2% of all tibial fractures in several series. With the use of intramedullary nail (IMN) of the tibia, current practice paraments suggest that transtibial tunnels should be avoided and ligamentous knee surgery be delayed until healing of the shaft fracture occurs. We report a novel case which was successfully managed by delayed IMN and multiligamentous transtibial posterior cruciate ligament (PCL) and posterolateral corner (PLC) autograft reconstructions. A 27-year-old male sustained a Gustilo-Anderson grade IIIa tibial shaft fracture and a Schenck IIIL knee dislocation (KD3L) in the ipsilateral knee. At 2 weeks, the patient was then taken back to the operating theater to undergo definitive bone fixation and ipsilateral simultaneous knee ligamentous reconstruction. The knee was stabilized by open reconstruction of the PCL under fluoroscopic control using an ipsilateral quadriceps autograft fixed with metallic interference screws. The PLC was reconstructed with ipsilateral semitendinosus autograft harvested through a separate 1.5-cm standard anteromedial incision using the technique described by Stannard et al. After graft fixation, the 90 degree posterior and posterolateral drawer and 0 and 30 degrees varus stress tests were negative. After 12 months follow-up, the patient had no complaints regarding pain or instability. The tibial fracture had healed and no knee axis deviation could be noted. The patient had returned to recreational low demand activities and motorcycle riding. Treatment of a combined tibial shaft fracture with an ipsilateral knee dislocation may be satisfactorily accomplished with an IMN for the tibia and transtibial tunnel fixation for knee ligament reconstruction allowing for a single rehabilitation course and a shorter recovery without having to use a third stage for knee ligamentous reconstruction.

scholarly journals The knee in congenital femoral deficiency and its implication in limb lengthening: a systematic review

2021 ◽  
Vol 6 (7) ◽  
pp. 565-571
Author(s):  
Chilan Bou Ghosson Leite ◽  
Patricia Moreno Grangeiro ◽  
Diego Ubrig Munhoz ◽  
Pedro Nogueira Giglio ◽  
Gilberto Luis Camanho ◽  
...  
Keyword(s):  
Lower Limb ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Dislocation ◽  
Limb Lengthening ◽  
Cruciate Ligaments ◽  
Knee Ligament ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Knee Ligament Reconstruction

Congenital femoral deficiency (CFD) is a rare disorder with several limb anomalies including limb shortening and knee cruciate ligament dysplasia. Limb lengthening is usually performed to correct lower limb discrepancy. However, complications, such as knee subluxation/dislocation, can occur during this treatment. Here, we explore CFD knee abnormalities and knee dislocation during limb elongation, discussing when and whether knee ligament reconstruction prior to the lengthening would be necessary to reduce the risk of knee dislocation. There is not enough support in the literature for the routine reconstruction of cruciate ligaments in CFD patients. Of note, in cases of severe anteroposterior or posterolateral rotatory instability, cruciate ligament reconstruction might be considered to decrease the risk of knee subluxation/dislocation during the lengthening treatment. Cite this article: EFORT Open Rev 2021;6:565-571. DOI: 10.1302/2058-5241.6.200075

scholarly journals Timing of Repair or Reconstruction after Knee Dislocation

2019 ◽  
Vol 33 (04) ◽  
pp. 335-338
Author(s):  
Gregory C. Fanelli
Keyword(s):  
Ligament Reconstruction ◽  
Head Injuries ◽  
Knee Dislocation ◽  
Organ System ◽  
Initial Assessment ◽  
Surgical Timing ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Assessment And Treatment ◽  
Injured Knee

AbstractThe multiple ligament injured knee (knee dislocation) is, often times, part of a multisystem injury complex that can include not only injuries to knee ligaments but also to blood vessels, skin, nerves, bones (fractures), head injuries, and other organ system trauma. These additional injuries can affect surgical timing for knee ligament reconstruction and also affect the results of the treatment. This article will present the author's approach and experience in the initial assessment and treatment of the acute multiple ligament injured (dislocated) knee, and also present considerations in the treatment of chronic multiple ligament injured knee.

scholarly journals Risk of tibial fracture after patella distallization and strategies for prevention

2017 ◽  
Vol 5 (5_suppl5) ◽  
pp. 2325967117S0019
Author(s):  
Roger Paterson
Keyword(s):  
Tibial Fracture ◽  
Case Reports ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Prevention Strategies ◽  
X Ray ◽  
Cortical Defect ◽  
Bone Segment ◽  
Bone Fragments

Objectives: To identify the risk of spontaneous proximal tibial shaft fracture after distallization of the patella, and prevention strategies. Methods: Case reports and operative technique. Two cases of tibial fracture are presented, arising from a stress riser in the tibial crest due to a residual anterior cortical defect. There had been no warning symptoms before the fractures. Results: The fractures required internal fixation of the proximal tibial shaft. Discussion: Prevention requires check X-Ray prior to return to full activity after patella distallization, and possible further surgery if a residual cortical defect is identified. At the time of the index surgery, the risk of a residual cortical defect can be minimized by ensuring accurate apposition of the two anterior bone fragments, and applying compression across the site of an oblique osteotomy between those fragments where a bone segment is resected. Conclusion: Awareness of this potential complication should ensure effective preventative strategies.

scholarly journals Modified fracture brace for tibial fracture with varus angulation: A case report

1995 ◽  
Vol 19 (2) ◽  
pp. 115-119 ◽  
Author(s):  
S. F. T. Tang ◽  
T. L. S. Au ◽  
A. M. K. Wong ◽  
M. Y. Lee
Keyword(s):  
Case Report ◽  
Tibial Fracture ◽  
Varus Deformity ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Knee Fracture ◽  
Varus Angulation ◽  
Fracture Brace

Sarmiento introduced the functional fracture brace for the management of tibial shaft fracture in 1963. However, tibial angulation with varus deformity cannot be prevented or corrected by such a device. In this paper, a case of tibial shaft fracture with varus angulation treated with a modified below-knee fracture brace was reported.

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