Management of posterior dislocation of knee in precarious se
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Complete dislocations of the knee are rare lesions and especially neglected forms are exceptional in literature. They are secondary to high energy trauma accompanied by multiple ligament ruptures, in particular the central pivot and in 10-25% with a paralysis of the common fibular nerve and less frequently a popliteal lesion . The diagnosis is based on clinical history, standard radiography as well as MRI and arteriography.

A 45-year-old motorcycle driver with no previous history of trauma had a collision with a car. He presented with a closed injury of the right knee. He was treated and followed by a traditional healer without success. He consulted 4 years after the accident because of lameness and functional deficits. The patient walked with a cane.

Clinical examination revealed:

An anterior bone protrusion of the femoral condyles with a desquamation of the facing skin which adhered strongly to the bone.A posterior projection of the tibia at the level of the popliteal recess.A shortening of the limb 5 cm relative to the contralateral side without vasculo-nervous disorder or pain. knee was blocked in extension without any mobility area.

The radiography of the knee showed a posterior dislocation of the knee with the formation of bone bridges between the femoral condyles and the anterior tibial tuberosity behind the femoro-tibial fusion of the patella .

The ultrasonography doppler performed did not show signs of arterial compression but the CT scan showed mass destruction of both the femoral and tibial articular cartilage. Then we found a formation of femoro-tibial bone bridges.

The patient was taken to the operation room. Under spinal anesthesia in the supine position we performed an antero-internal incision of 12 cm, cutaneous detachment with bone pellets and then section of the bridges. A resection of the cartilage on both sides was done, then a reduction and two spongy screws crossed X reinforced by two pins of Steiman (Figures 3 and 4) were inserted . The limb was then immobilized in a plastered knee joint.

At the 5-year follow-up the patient was reviewed and evaluated at the functional (monopodal) and radiological level Clinically the knee was stable with a residual shortening of 1 cm and the radiograph showed good femoral-tibial bone fusion.

Knee dislocation is a rare disease and a neglected form is still exceptionally rare in the literature. The femoro-tibial arthrodesis was the only alternative for the management of our patient with regard to the degree of destruction of both the femoral and tibial cartilage

Source: http://ispub.com/IJOS/26/1/52766
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