PMC7378631_01
(a, b) Anteroposterior radiography of the knees showing a Segond fracture associated with an arcuate fracture. (c, d) CT of right knee in coronal view and left knee in sagittal view showing avulsion of the fibular head associated with avulsion fracture of the left with small fragments. (e, f) Right knee axial CT sequence.
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Radiographic examination of the knees showed bilateral avulsion fractures of the fibular head associated with the arcuate signal, being classified as AO/ASIF 41 A19 (Figure 1). Tomography) scan of both knees was performed (Figure 1).
(a) Lateral approach to the right knee showing the tendon of the long head of the biceps repaired by Krackow suture, identified and isolated fibular nerve, fibular head with avulsed fragment and lateral margin of the tibia with the iliotibial band completely inserted to the full. (b) Right knee after Segond fragment fixation and transosseous PLC repair. (c) Lateral approach to the left knee showing extensive injury on the lateral edge of the tibia near the iliotibial band and comminuted avulsion fracture of the fibular head next to the tendon of the long head of the intact biceps. (d) Left knee after Segond fracture fixation with pull out associated with Kirschner wires and transosseous PLC repair (green asterisk = tendon of the long head of the biceps; yellow asterisk = fibular nerve; white asterisk = head of the fibula with avulsed fragment; blue asterisk = lateral edge of the tibia with iliotibial band completely inserted in full; red arrow = mini access for positioning of pull-out plate).
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Krackow suture was performed with No. 5 ethibond thread in the conjoint tendon together with the posterolateral ligament complex (Figure 2(a)). TN, USA). Transosseous tunnels were performed in the fibular head (10 mm distal to the fracture line and were 15 mm away from each other) to fix the posterolateral ligament complex (Figure 2(b)). Krackow suture was performed in the conjoint tendon together with the posterolateral ligament complex (PLC) and another suture, separately, in the iliotibial band (Figure 2(c)). The ALL complex was fixed by a pull-out technique, creating a transtibial tunnel and tied to a 3.5 DCP plate (Medtronic Sofamor Danek Inc., Memphis, TN, USA) in an anterior cortex placed through anterior mini access (Figure 2(d)).
Anteroposterior radiographs pos operative and lateral view of the right knee (a, b) and left knee (c, d).
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Control radiography was performed intraoperatively on both knees (Figure 3).
(a, b) Supine photograph showing full range of motion of hips, knees, and ankles.
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She had normal walking with a full range of motion of the hip, knee, and ankle (Figure 4).