Skip to main content

Fracture-dislocations: Evaluation and Treatment

  • Chapter
  • First Online:
  • 2201 Accesses

Abstract

Fracture-dislocations of the knee are rare and difficult injuries to treat that demand understanding of the mechanics of the fracture and the dislocation, the treatment principles of the ligamentous and osseous injury, and the surgical timing and rationale. Different fracture patterns portend unique information about the injury and must be evaluated and treated differently. This chapter is divided into common fracture-dislocation patterns: avulsion and marginal plateau fractures, intra-articular and weight-bearing fractures, and fractures remote to the knee injury. In this chapter we use the published literature and our own clinical experience to discuss the diagnosis and treatment of knee fracture-dislocations.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963;45:889–904.

    PubMed  CAS  Google Scholar 

  2. Schenck Jr RC. The dislocated knee. Instr Course Lect. 1994;43:127–36.

    PubMed  Google Scholar 

  3. Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11(7):525–9.

    Article  PubMed  CAS  Google Scholar 

  4. Stannard JP, et al. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am. 2004;86-A(5):910–5.

    PubMed  Google Scholar 

  5. Wascher DC. High-velocity knee dislocation with vascular injury. Treatment principles. Clin Sports Med. 2000;19(3):457–77.

    Article  PubMed  CAS  Google Scholar 

  6. Moore TM. Fracture-dislocation of the knee. Clin Orthop Relat Res. 1981;156:128–40.

    PubMed  Google Scholar 

  7. Merritt AL, Wahl CJ. Management of the Multiple Ligament Injured (Dislocated) Knee—the Seattle Perspective. Operative Techniques in Sports Medicine. Drez, DeLee, and Fanelli, eds. March, 2011.

    Google Scholar 

  8. Lustig S, et al. Dislocation and bicruciate lesions of the knee: epidemiology and acute stage assessment in a prospective series. Orthop Traumatol Surg Res. 2009;95(8):614–20.

    Article  PubMed  CAS  Google Scholar 

  9. Rios A, et al. Results after treatment of traumatic knee dislocations: a report of 26 cases. J Trauma. 2003;55(3):489–94.

    Article  PubMed  Google Scholar 

  10. Twaddle BC, Bidwell TA, Chapman JR. Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma. 2003;17(3):198–202.

    Article  PubMed  Google Scholar 

  11. Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br. 2005;87(5):664–7.

    Article  PubMed  CAS  Google Scholar 

  12. Honkonen SE. Indications for surgical treatment of tibial condyle fractures. Clin Orthop Relat Res. 1994;302:199–205.

    PubMed  Google Scholar 

  13. Burri C, et al. Fractures of the tibial plateau. Clin Orthop Relat Res. 1979;138:84–93.

    PubMed  Google Scholar 

  14. Delamarter RB, Hohl M, Hopp Jr E. Ligament injuries associated with tibial plateau fractures. Clin Orthop Relat Res. 1990;250:226–33.

    PubMed  Google Scholar 

  15. Segond, Reserches cliniques et experimentes sur les epanchements sanguins du genou par entorse. Prog Med. 1879;7:297–419

    Google Scholar 

  16. Dietz GW, Wilcox DM, Montgomery JB. Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology. 1986;159(2):467–9.

    PubMed  CAS  Google Scholar 

  17. Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: X-ray clue to a significant knee instability. Am J Sports Med. 1979;7(1):27–33.

    Article  PubMed  CAS  Google Scholar 

  18. Goldman AB, Pavlov H, Rubenstein D. The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol. 1988;151(6):1163–7.

    PubMed  CAS  Google Scholar 

  19. el-Khoury GY, Daniel WW, Kathol MH. Acute and chronic avulsive injuries. Radiol Clin North Am. 1997;35(3):747–66.

    PubMed  CAS  Google Scholar 

  20. Delzell PB, Schils JP, Recht MP. Subtle fractures about the knee: innocuous-appearing yet indicative of significant internal derangement. AJR Am J Roentgenol. 1996;167(3):699–703.

    PubMed  CAS  Google Scholar 

  21. Campos JC, et al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology. 2001;219(2):381–6.

    PubMed  CAS  Google Scholar 

  22. Sharma H, et al. Type IIIB tibial intercondylar eminence fracture associated with a complex knee dislocation in a grossly obese adult. Knee Surg Sports Traumatol Arthrosc. 2005;13(4):313–6.

    Article  PubMed  CAS  Google Scholar 

  23. Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol. 1997;26(9):553–5.

    Article  PubMed  CAS  Google Scholar 

  24. Escobedo EM, Mills WJ, Hunter JC. The “reverse Segond” fracture: association with a tear of the posterior cruciate ligament and medial meniscus. AJR Am J Roentgenol. 2002;178(4):979–83.

    PubMed  Google Scholar 

  25. Engelsohn E, Umans H, Difelice GS. Marginal fractures of the medial tibial plateau: possible association with medial meniscal root tear. Skeletal Radiol. 2007;36(1):73–6.

    Article  PubMed  Google Scholar 

  26. Archbold HA, Sloan S, Nicholas R. A tibial plateau fracture in a knee dislocation: a subtle sign of major ligamentous disruption. Injury. 2004;35(9):945–7.

    Article  PubMed  CAS  Google Scholar 

  27. DeLee JC, Riley MB, Rockwood Jr CA. Acute straight lateral instability of the knee. Am J Sports Med. 1983;11(6):404–11.

    Article  PubMed  CAS  Google Scholar 

  28. Cohen AP, King D, Gibbon AJ. Impingement fracture of the anteromedial tibial margin: a radiographic sign of combined posterolateral complex and posterior cruciate ligament disruption. Skeletal Radiol. 2001;30(2):114–6.

    Article  PubMed  CAS  Google Scholar 

  29. Eustace S. In: Eustace S, editor. Magnetic resonance imaging of orthopaedic trauma. Philadelphia, PA: Lippincott, Williams and Wilkins; 1999

    Google Scholar 

  30. Vanek J. Posteromedial fracture of the tibial plateau is not an avulsion injury. A case report and experimental study. J Bone Joint Surg Br. 1994;76(2):290–2.

    PubMed  CAS  Google Scholar 

  31. Yao L, Lee JK. Avulsion of the posteromedial tibial plateau by the semimembranosus tendon: diagnosis with MR imaging. Radiology. 1989;172(2):513–4.

    PubMed  CAS  Google Scholar 

  32. Garth Jr WP, Wilson T. Open reduction of a lateral femoral notch associated with an acute anterior cruciate ligament tear. Arthroscopy. 2001;17(8):874–7.

    PubMed  Google Scholar 

  33. Sadlo PA, Nebelung W. Arthroscopically assisted reduction of a lateral femoral notch in acute tear of the anterior cruciate ligament. Arthroscopy. 2006;22(5):574e1–3.

    Google Scholar 

  34. Shindell R, Walsh WM, Connolly JF. Avulsion fracture of the fibula: the “arcuate sign” of posterolateral knee instability. Nebr Med J. 1984;69(11):369–71.

    PubMed  CAS  Google Scholar 

  35. Huang GS, et al. Avulsion fracture of the head of the fibula (the “arcuate” sign): MR imaging findings predictive of injuries to the posterolateral ligaments and posterior cruciate ligament. AJR Am J Roentgenol. 2003;180(2):381–7.

    PubMed  Google Scholar 

  36. Lee J, et al. Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury. Skeletal Radiol. 2003;32(11):619–27.

    Article  PubMed  Google Scholar 

  37. Nakhostine M, Perko M, Cross M. Isolated avulsion of the popliteus tendon. J Bone Joint Surg Br. 1995;77(2):242–4.

    PubMed  CAS  Google Scholar 

  38. Siliski JM, Mahring M, Hofer HP. Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am. 1989;71(1):95–104.

    PubMed  CAS  Google Scholar 

  39. Hutson Jr JJ, Zych GA. Treatment of comminuted intraarticular distal femur fractures with limited internal and external tensioned wire fixation. J Orthop Trauma. 2000;14(6):405–13.

    Article  PubMed  Google Scholar 

  40. Schenck Jr RC, McGanity PL, Heckman JD. Femoral-sided fracture-dislocation of the knee. J Orthop Trauma. 1997;11(6):416–21.

    Article  PubMed  Google Scholar 

  41. Shetty GM, et al. Incarcerated patellar tendon in Hoffa fracture: an unusual cause of irreducible knee dislocation. Knee Surg Sports Traumatol Arthrosc. 2008;16(4):378–81.

    Article  PubMed  Google Scholar 

  42. Holmes SM, Bomback D, Baumgaertner MR. Coronal fractures of the femoral condyle: a brief report of five cases. J Orthop Trauma. 2004;18(5):316–9.

    Article  PubMed  Google Scholar 

  43. Wallenbock F, Ledinski C. Indications and limits of arthroscopic management of intra-articular fractures of the knee joint. Aktuelle Traumatol. 1993;23(2):97–101.

    PubMed  CAS  Google Scholar 

  44. McCarthy JJ, Parker RD. Arthroscopic reduction and internal fixation of a displaced intraarticular lateral femoral condyle fracture of the knee. Arthroscopy. 1996;12(2):224–7.

    Article  PubMed  CAS  Google Scholar 

  45. Demirel M, et al. Arthroscopically assisted intra-articular lateral femoral condyle fracture surgery. Arthroscopy. 2006;22(6):69e1–4.

    Google Scholar 

  46. Schatzker J, McBroom R, Bruce D. The tibial plateau fracture. The Toronto experience 1968–1975. Clin Orthop Relat Res. 1979;138:94–104.

    PubMed  Google Scholar 

  47. Colletti P, Greenberg H, Terk MR. MR findings in patients with acute tibial plateau fractures. Comput Med Imaging Graph. 1996;20(5):389–94.

    Article  PubMed  CAS  Google Scholar 

  48. Gardner MJ, et al. Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs. J Trauma. 2006;60(2):319–23. discussion 324.

    Article  PubMed  Google Scholar 

  49. Gardner MJ, et al. The incidence of soft tissue injury in operative tibial plateau fractures: a magnetic resonance imaging analysis of 103 patients. J Orthop Trauma. 2005;19(2):79–84.

    Article  PubMed  Google Scholar 

  50. Mohan R, de Boer PG. Dislocation of the knee with ipsilateral tibial metaphyseal fracture. Injury. 1999;30(5):377–9.

    Article  PubMed  CAS  Google Scholar 

  51. Kosanovic M, Komadina R, Batista M. Patella fractures associated with injuries of the knee ligament. Arch Orthop Trauma Surg. 1998;117(1–2):108–9.

    Article  PubMed  CAS  Google Scholar 

  52. Liow RY, et al. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br. 2003;85(6):845–51.

    PubMed  CAS  Google Scholar 

  53. Moore TM, Patzakis MJ, Harvey Jr JP. Ipsilateral diaphyseal femur fractures and knee ligament injuries. Clin Orthop Relat Res. 1988;232:182–9.

    PubMed  Google Scholar 

  54. De Campos J, et al. Ipsilateral knee injury with femoral fracture. Examination under anesthesia and arthroscopic evaluation. Clin Orthop Relat Res. 1994;300:178–82.

    PubMed  Google Scholar 

  55. Giannoudis PV, et al. Knee dislocation with ipsilateral femoral shaft fracture: a report of five cases. J Orthop Trauma. 2005;19(3):205–10.

    Article  PubMed  Google Scholar 

  56. Matthews DE, Jones GS, Hughes JL. Femur fracture with ipsilateral knee dislocation. Orthopedics. 1993;16(8):917–9.

    PubMed  CAS  Google Scholar 

  57. van Raay JJ, Raaymakers EL, Dupree HW. Knee ligament injuries combined with ipsilateral tibial and femoral diaphyseal fractures: the “floating knee”. Arch Orthop Trauma Surg. 1991;110(2):75–7.

    Article  PubMed  Google Scholar 

  58. Walling AK, Seradge H, Spiegel PG. Injuries to the knee ligaments with fractures of the femur. J Bone Joint Surg Am. 1982;64(9):1324–7.

    PubMed  CAS  Google Scholar 

  59. Walker DM, Kennedy JC. Occult knee ligament injuries associated with femoral shaft fractures. Am J Sports Med. 1980;8(3):172–4.

    Article  PubMed  CAS  Google Scholar 

  60. Dickob M, Mommsen U. Damage to the knee ligament as a concomitant injury in femoral shaft fractures. Unfallchirurgie. 1992;18(4):218–23.

    Article  PubMed  CAS  Google Scholar 

  61. Gupta S, Fazal MA, Haddad F. Traumatic anterior knee dislocation and tibial shaft fracture: a case report. J Orthop Surg (Hong Kong). 2007;15(1):81–3.

    CAS  Google Scholar 

  62. Szalay MJ, Hosking OR, Annear P. Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures. Injury. 1990;21(6):398–400.

    Article  PubMed  CAS  Google Scholar 

  63. Chen CE, Wang JW. Floating knee with ipsilateral knee dislocation: case report. J Trauma. 1998;44(4):735–7.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher J. Wahl M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Merritt, A.L., Chun, K.F., Wahl, C.J. (2013). Fracture-dislocations: Evaluation and Treatment. In: Fanelli, G. (eds) The Multiple Ligament Injured Knee. Springer, New York, NY. https://doi.org/10.1007/978-0-387-49289-6_27

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-49289-6_27

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-49287-2

  • Online ISBN: 978-0-387-49289-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics