PMC3504239_01
Preoperative X-ray of the right knee AP and lateral views showing fracture distal femur and proximal tibia.
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fig1
X-ray of the right knee revealed fracture distal femur OTA A3 and fracture proximal tibia OTA A2 (Figure 1). 
Fracture distal femur being fixed with DCS by MIPO.
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fig2
DCS fixation by bridge plating technique for the distal femur and lateral buttress plating by MIPO technique for proximal tibia were planned and executed under spinal anesthesia with image intensifier (Figure 2).
Intraoperative picture showing torn ends of patellar tendon.
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fig3
We were surprised to find the torn patellar tendon (Figure 3) along with avulsion of VMO from the medial border of patella and torn MPFL (Figure 4). 
Patella tilted 90  laterally (white arrow points to articular surface) to show the bare medial border (green arrow) from where VMO and MPFL were torn.
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fig4
We were surprised to find the torn patellar tendon (Figure 3) along with avulsion of VMO from the medial border of patella and torn MPFL (Figure 4). 
Patellar tendon repaired and protected with a figure of 8 wiring.
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fig5
The patellar tendon was protected by a figure of 8 tension band through patella and tibial tuberosity (Figure 5).
X-ray right leg AP and lateral views at 2-year followup showing fracture union.
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fig8
Weight bearing was allowed after radiological union of both the fractures after 3 months. 90 degrees of knee flexion was achieved by 6 months and the figure of 8 TBW was removed at that time (Figure 6). At 2-year followup, the patient has got a stable knee with the ROM of 0 to 100 degrees without any extensor lag or lateral patellar subluxation (Figures 7, 8, 9, and 10).
PMC3504239_02
3-month followup X-ray of the right knee AP showing fracture union.
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fig6
Weight bearing was allowed after radiological union of both the fractures after 3 months. 90 degrees of knee flexion was achieved by 6 months and the figure of 8 TBW was removed at that time (Figure 6).
X-ray right femur AP and lateral views at 2-year followup showing fracture union.
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fig7
At 2-year followup, the patient has got a stable knee with the ROM of 0 to 100 degrees without any extensor lag or lateral patellar subluxation (Figures 7, 8, 9, and 10).
X-ray right leg AP and lateral views at 2-year followup showing fracture union.
CRIM.ORTHOPEDICS2012-913230.008.jpg
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fig8
Weight bearing was allowed after radiological union of both the fractures after 3 months. 90 degrees of knee flexion was achieved by 6 months and the figure of 8 TBW was removed at that time (Figure 6). At 2-year followup, the patient has got a stable knee with the ROM of 0 to 100 degrees without any extensor lag or lateral patellar subluxation (Figures 7, 8, 9, and 10).
Clinical picture at 2-year followup after figure of 8 wire removal showing active SLR.
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fig9
At 2-year followup, the patient has got a stable knee with the ROM of 0 to 100 degrees without any extensor lag or lateral patellar subluxation (Figures 7, 8, 9, and 10).
Clinical picture at 2-years followup after figure of 8 wire removal showing knee flexion up to 100 .
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fig10
At 2-year followup, the patient has got a stable knee with the ROM of 0 to 100 degrees without any extensor lag or lateral patellar subluxation (Figures 7, 8, 9, and 10).