PROBLEM

A 19 yrs old boy was involved in an accident and sustained injury to the right knee. He was admitted with severe pain in the right knee, severe deformity and inability to bear weight on the right leg. There was a bleeding wound on the front of the knee.

Clinical examination revealed a fracture- dislocation of the right knee. The pulses in the right foot were absent.

A vascular surgeon’s opinion was obtained and he confirmed the presence of injury to the blood vessels behind the knee, caused by the dislocated bone fragments

TREATMENT

He was taken up for surgery immediately. The open wound was debrided thoroughly, the fracture was opened, the dislocated fragment behind the knee was reduced and the fractures were fixed with two buttress plates and screws and wires. Once the fractures were fixed, the vascular surgeon explored the injured vessels in the popliteal fossa.

The tear in the posterior tibial vessel was repaired with a reversed vein graft. A tear in the anterior tibial vessel was directly repaired.

Post- op there was good flow in the repaired vessels and the foot pulses were well felt.

POST- OP RADIOGRAPHS

The open wound in the front of the knee was debrided again after 48h and required a split- thickness skin graft cover.

RESULTS

At 6 months, he has no pain in the knee. He is walking independently putting full weight on the right leg. He has full movement in the right knee. There were no complications