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

• Published in: BMC musculoskeletal disorders 2022-05, Vol.23 (1), p.431-431, Article 431
• Main Authors: Vosoughi, Farzad, Vosoughi, Fardis, Kalantar, Seyed Hadi
• Format: Article
• Language: English
• Subjects: Adult; Blood pressure; Case Report; Case reports; Classification; Compartment syndrome; Debridement; Disasters; Dislocation; External fixator; Foreign bodies; Fracture Fixation, Internal; Fractures; Fractures, Open - diagnostic imaging; Fractures, Open - surgery; Humans; Intra-Articular Fractures; Joint and ligament injuries; Joint Dislocations - surgery; Knee; Knee Dislocation - surgery; Knee fracture dislocation; Knee Injuries - complications; Knee Injuries - diagnostic imaging; Knee Injuries - surgery; Lavage; Ligaments; Meniscus; Musculoskeletal diseases; Nonunion; Open fracture; Orthopedics; Patellar Ligament - diagnostic imaging; Patellar Ligament - injuries; Patellar Ligament - surgery; Rupture; Surgery; Sutures; Tendon Injuries; Tetanus; Trauma
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-022-05268-y

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 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. 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. 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.