Zhao Daohong, Li Weiqiang, Liu Luping, Lu Ning, Chen Leijie, Zhang Jun
Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China.
BMC Surg. 2020 May 25;20(1):114. doi: 10.1186/s12893-020-00770-3.
Both tibial plateau fractures and extensor apparatus injuries are serious injuries to the knee joint that generally do not occur in the same patient. We report a rare case of open tibial plateau fracture combined with quadriceps tendon rupture and complete displacement of the patella into the tibial plateau fracture.
The case involved a male who was 19 years old who had been in a motorcycle accident. The patient was admitted to our department with an open tibial plateau fracture 3 h post-injury. X-ray showed a tibial plateau fracture and complete displacement of the patella into the tibial plateau. CT showed an avulsion fracture in the patella and tibial intercondylar eminence. Concomitant quadriceps tendon injury and both anterior and posterior cruciate ligament tibial insertion avulsion fractures were considered. The operative findings of emergency surgery confirmed our preoperative diagnosis. Single-stage quadriceps tendon repair and ORIF for the tibial plateau fracture were performed. Satisfactory restoration of function was acquired at the last follow up.
The most difficult aspect of this case was the determination of the cause of the intra-osseous dislocation of the patella into the tibial plateau. The most likely mechanism of the injury may be that the patient experienced transient posterior dislocation of the knee during the injury. Rupture of the quadriceps tendon should be considered with posterior dislocation of the knee, and the patella was pushed into the tibial plateau fracture by force after the rupture of the quadriceps tendon.
胫骨平台骨折和伸膝装置损伤均为膝关节的严重损伤，通常不会发生在同一患者身上。我们报告了一例罕见的开放性胫骨平台骨折合并股四头肌肌腱断裂及髌骨完全移位至胫骨平台骨折处的病例。
该病例为一名19岁男性，因摩托车事故入院。患者受伤后3小时因开放性胫骨平台骨折被收入我科。X线显示胫骨平台骨折及髌骨完全移位至胫骨平台。CT显示髌骨和胫骨髁间隆起撕脱骨折。考虑合并股四头肌肌腱损伤及前后交叉韧带胫骨止点撕脱骨折。急诊手术的术中发现证实了我们的术前诊断。对胫骨平台骨折进行了一期股四头肌肌腱修复和切开复位内固定术。末次随访时功能恢复满意。
该病例最困难的方面是确定髌骨向胫骨平台骨内脱位的原因。最可能的损伤机制可能是患者在受伤时膝关节发生短暂的后脱位。膝关节后脱位时应考虑股四头肌肌腱断裂，股四头肌肌腱断裂后髌骨被强行推入胫骨平台骨折处。
