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CC BY 4.0 · Surg J (N Y) 2020; 06(03): e160-e163
DOI: 10.1055/s-0040-1716685
Case Report

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

Túlio Vinícius de Oliveira Campos 
1   Departamento de Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
2   Orthopaedic Surgery Department, Hospital Risoleta Tolentino Neves, Sociedade Brasileira de Cirurgia do Joelho, São Paulo, Brazil
,
Marcelo Nacif Moraes
2   Orthopaedic Surgery Department, Hospital Risoleta Tolentino Neves, Sociedade Brasileira de Cirurgia do Joelho, São Paulo, Brazil
3   Knee Surgery Department, Hospital da Baleia, Fundação Benjamin Guimarães, Belo Horizonte, Minas Gerais, Brazil
,
Marco Antônio Percope de Andrade 
1   Departamento de Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
2   Orthopaedic Surgery Department, Hospital Risoleta Tolentino Neves, Sociedade Brasileira de Cirurgia do Joelho, São Paulo, Brazil
,
Robert C. Schenck Jr
4   Department of Orthopaedic Surgery and Rehabiliation, University of New Mexico Health Science Center, Albuquerque, New Mexico
,
Simon T. Donell 
5   Knee Surgery Department, Norwich Medical School, Norwich, United Kingdom
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Abstract

Knee 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.

Keywords

knee dislocation - tibia shaft fracture - posterior cruciate ligament - intramedullary nailing


Publication History

Received: 05 March 2019

Accepted: 12 May 2020

Article published online:
28 September 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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