![]() An iatrogenic ramp lesion (meniscocapsular separation) was created to improve exposure, and this was repaired primarily upon closure. ![]() This was accomplished via the posteromedial approach utilized for bony fixation that was extended intracapsularly. The bony PCL avulsion fragment, including the insertion of the posterior horn of the lateral meniscus, was repaired using proximal and distal button fixation bridged with SutureTape. The proximal tibial locking plate was used after fragment-specific fixation in neutralization mode for definitive fixation. Multiple minifragment plates and independent lag screws were used for fragment-specific fixation and provisional reduction control. Intraoperative fluoroscopy radiographs showed near anatomic restoration of the bony anatomy (Fig. Preoperative planning with orthopaedic trauma and sports medicine teams called for stable bony fixation, capsule and PCL repair, and tibiofibular proximal joint stabilization. 3).įigure 1: Anteroposterior (AP) radiograph shows spanning external fixation.įigure 3: MRI shows a secondary deformity of the PCL due to avulsion of the PCL footprint, with a slightly displaced footprint fracture. ![]() Magnetic resonance imaging (MRI) confirmed a lateral meniscal root tear, disruption of the PCL, proximal tibiofibular capsular ligaments, and moderate posterolateral corner injury (Fig. A computed tomography (CT) scan showed the complex proximal tibia fracture with a separate tibial tubercle fragment and confirmed a posterior cruciate ligament (PCL) avulsion fracture and lateral proximal tibia avulsion (Fig. Diastasis of the proximal fibula from the tibia demonstrated the high energy nature of the trauma. Subtle findings of a proximal lateral tibia avulsion fracture (a Segond fracture) and tibial spine comminution raised suspicion for ligamentous knee instability. Radiographs showed a complex, largely extra-articular, proximal tibia fracture with dissociation of the tibial tubercle (Fig. The external fixator pin sites showed no evidence of infection. He traveled home 3 days after injury on deep vein thrombosis (DVT) prophylaxis with enoxaparin.Īt presentation 1 week after injury, the patient was neurovascularly intact with resolving fracture blisters. There were no signs of compartment syndrome, and except for Crohn’s disease treated with vedolizumab, he was healthy. While skiing at high speed, a 37-year-old man lost control, struck his left lower leg against a tree, and sustained a complex proximal tibia and fibula fracture initially managed with an external fixator. From Grand Rounds from HSS: Management of Complex Cases | Volume 12, Issue 1 Case Report
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