PMC6878807_01
Picture demonstrating the wounds sustained in the initial injury, with underlying exposed bone of the fracture site.
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Trauma Life Support (ATLS) standards and was determined to be hemodynamically stable with an isolated orthopaedic injury to his left lower extremity. The left lower extremity had two visible approximately 5 cm wounds over the anterior knee (Figure 1). There were two large wounds, one overlying the anterior tibia (with visualized tubercle fracture) as well as one overlying the patella (Figure 1).
Lateral radiograph demonstrating tibial tubercle fracture and comminuted patellar fracture with overlying soft tissue defects.
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Initial radiographs showed a tibial tubercle fracture and comminuted patella fracture (Figure 2).
CT scan delineating the vertical, coronal plane fracture line of the extra-articular tibial tubercle fracture with overlying soft tissue injury. Also demonstrates a large bony defect in the patella, confirming the comminute nature of the fracture.
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Computerized tomography (CT) scan was acquired that showed a vertical fracture line in the coronal plane of the tibial tubercle and comminuted patellar fracture (Figure 3).
Intraoperative fluoroscopic images confirming anatomic reduction of the tibial tubercle fragment with 4.0 cannulated bicortical screws, placed in a lag screw fashion.
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Screw placement was confirmed under fluoroscopy to be in adequate position (Figure 4).
An illustration demonstrating the unique, purse-string technique employed for fixation of the patella fracture with overlying soft tissue deficit.
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Following compression, a #2 fibre wire was placed in a cerclage, purse-string fashion around the patellar retinacular soft tissue and hand tied under tension (Figure 5).
An illustration demonstrating the placement of anchor suture drill holes for fixation of the patellar tendon insertion, bypassing previously fixated fracture site.
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The anchors were advanced from anterior to posterior through the fracture fragment and into a stable tibial bone (Figure 6).
Intraoperative clinical picture showing the completed repair of the tibial tubercle fracture, patellar fracture, and patellar tendon avulsion.
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The entire extensor mechanism repair was tested under flexion without evidence of gapping at the tibial tubercle fracture site, patellar fracture site, or patellar tendon repair site (Figure 7).
Clinical photograph at first follow-up visit showing well-healing wounds without evidence of skin necrosis, wound breakdown, erythema, or drainage.
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First follow-up visit occurred 10 days after surgery and showed well-healing wounds without evidence of skin necrosis (Figure 8).
AP and lateral radiograph taken at 1-year follow-up showing healed fracture and no evidence of hardware complications.
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X-rays from final follow-up are shown in Figure 9.