C Quintart1, R Elbaum. 1. Département d'orthopédie traumatologie de l'A.H.E. Ixelles, Bruxelles.
Abstract
PURPOSE OF THE STUDY: The authors report one case of isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. They recommend the use of 3D CT Scan to appreciate the size, the displacement of the bone fragment or the occurrence of comminuted fracture. MATERIAL AND METHOD: A 12 years old girl was admitted for knee pain and swelling secondary to horse's hoof blow on the anterior aspect of the proximal tibia. Hemarthrosis, contusion of the anterior surface of the proximal tibia were present. Because of pain and swelling, the knee could not be examined with accuracy. Roentgenographic examination showed isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. 3D CT Scan confirmed the lesion. Bony fragment was displaced and was not comminuted. Approach through the popliteal fossa was used and bony fragment was screwed back into its bed. RESULTS: Postoperatively, a long leg plaster of Paris was applied for 6 weeks. The patient was followed for 1.5 year. She returned to her previous occupation. There was no residual laxity. X ray confirmed fracture union. DISCUSSION: Results of primary repair of interstitial posterior cruciate ligament tears were inconsistent. On the contrary, good functional results were obtained with surgically treated avulsion fracture of the posterior cruciate ligament. Displaced bony fragment will be fixed properly to its bed. 3D CT Scan appreciate the size, the displacement or the occurrence of comminuted fracture. Those informations help to define surgical procedure: screw, wire-suture or staple.
PURPOSE OF THE STUDY: The authors report one case of isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. They recommend the use of 3D CT Scan to appreciate the size, the displacement of the bone fragment or the occurrence of comminuted fracture. MATERIAL AND METHOD: A 12 years old girl was admitted for knee pain and swelling secondary to horse's hoof blow on the anterior aspect of the proximal tibia. Hemarthrosis, contusion of the anterior surface of the proximal tibia were present. Because of pain and swelling, the knee could not be examined with accuracy. Roentgenographic examination showed isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. 3D CT Scan confirmed the lesion. Bony fragment was displaced and was not comminuted. Approach through the popliteal fossa was used and bony fragment was screwed back into its bed. RESULTS: Postoperatively, a long leg plaster of Paris was applied for 6 weeks. The patient was followed for 1.5 year. She returned to her previous occupation. There was no residual laxity. X ray confirmed fracture union. DISCUSSION: Results of primary repair of interstitial posterior cruciate ligament tears were inconsistent. On the contrary, good functional results were obtained with surgically treated avulsion fracture of the posterior cruciate ligament. Displaced bony fragment will be fixed properly to its bed. 3D CT Scan appreciate the size, the displacement or the occurrence of comminuted fracture. Those informations help to define surgical procedure: screw, wire-suture or staple.