RESUMO
Introduction: Tibial plateau fractures are very complex articular fractures with a rare incidence of approximately 10.3%. These fractures may constitute a severe injury to the knee joint and other complications. Presentation of case: A 23- year-old male injured his right knee after a crush accident and was diagnosed with a posterio-latero-central (PLC) sheared fracture of the tibial plateau without an injury to knee ligaments. CT with a reconstruction of the right knee showed that the fracture was accompanied by a free fragment inserted into the anterior compartment of the knee. The free fragment was repositioned to its native location and was fixed with three Herbert screws. Also, we found a peripheral avulsion of the posterio-lateral (PL) portion of the lateral meniscus from the capsular attachment, which was repaired with vicryl absorbable suture. An above knee cast was put in 15-degree flexion for three weeks followed by a restoration of knee movements and weight-bearing after ten weeks of surgery. The patient had a full range of motions and no signs of joint laxity after one year of operation. Discussion conclusion: This study revealed that the surgical repair allowed a quick return to movement for a PLC sheared fracture of the tibial plateau and can be fixed sufficiently to achieve excellent postoperative recovery.
RESUMO
Introduction and importance: Gustilo-Anderson type 3 open tibial fractures are commonly accompanied by extensive damage and serious complications, especially in types 3B and 3C. Case presentation: A 25-year-old male was transferred after motor vehicle accident and the emergent choice was an above-knee amputation in other two hospital. A left open distal tibial fracture (Gustilo type 3C) with a wide and contaminated soft tissues defect, that extended from the knee to the midfoot, is accompanied by wasting of the anterior compartment muscles and ruptured of the anterior tibial artery. We did irrigation and debridement and then we placed an anteriomedial external fixation system type AO with pins. A cross-leg flap and free skin grafts from the opposite limb was performed three weeks after a daily irrigation and debridement, povidon and ozone cream bandages, and antibiotics. After twelve months of follow-up, the fracture was healed and the external fixator was removed. Discussion/conclusion: Gustilo-Anderson type 3 open fractures remain a veritable orthopedic challenge, even for surgeons with greater experience, because of neurovascular damages, high amputation rate, and vast soft tissue injuries. The collaboration of the multidisciplinary surgical team led to preserve the limb with good result after one year. It is reasonable to judge and attempt a limb preservation even with wide open tibial fractures.
