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Open tibia plateau fracture with intra-osseous dislocation of the patella and quadriceps tendon rupture: a case report

开放性胫骨平台骨折伴髌骨骨内脱位和股四头肌腱断裂 1 例

  • 影响因子:1.82
  • DOI:10.1186/s12893-020-00770-3
  • 作者列表:"Daohong Zhao","Weiqiang Li","Luping Liu","Ning Lu","Leijie Chen","Jun Zhang
  • 发表时间:2020-05-31
Abstract

Abstract Background 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. Case presentation 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. Conclusion 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.

摘要

文摘背景胫骨平台骨折和伸肌器损伤都是膝关节的严重损伤,一般不会发生在同一患者身上。我们报告 1 例罕见的开放性胫骨平台骨折合并股四头肌腱断裂,髌骨完全移位进入胫骨平台骨折。案例介绍该案件涉及一名 19 岁的男性,他曾遭遇摩托车事故。患者因开放性胫骨平台骨折伤后 3 h 入院。X线显示胫骨平台骨折,髌骨完全移位进入胫骨平台。CT 显示髌骨和胫骨髁间隆起撕脱骨折。同时考虑股四头肌肌腱损伤和前后交叉韧带胫骨止点撕脱骨折。急诊手术的手术结果证实了我们的术前诊断。采用一期股四头肌腱修复和 ORIF 治疗胫骨平台骨折。末次随访时功能恢复满意。结论该病例最困难的方面是确定髌骨骨内脱位进入胫骨平台的原因。最可能的损伤机制可能是患者在损伤过程中出现一过性膝关节后脱位。股四头肌腱断裂应考虑为膝后脱位,股四头肌腱断裂后将髌骨用力推入胫骨平台骨折。

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