PELVIC RING INJURY ASSOCIATED WITH FLOATING KNEE AND IPSILATERAL POSTERIOR CRUCIATE LIGAMENT (PCL) AVULSION FRACTURE: AN EXPERIENCE

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Abstract

Pelvic ring injury associated with floating knee is relatively rare1. For our best acquaintance, few literatures have documented such injuries in an individual patient. The aim of this study is to validate the feasibility of damage control orthopedics (DCO). Method: A 15-years-old girl, involved in high-energy road traffic accident presented with hemodynamic instability. The pelvis was unstable with deformity in the right upper and lower extremities. Significant lacerations over forehead, right forearm and thigh present. Her radiographs proved the unstable pelvis fracture[A], multiple fractures of right lower limb with floating knee injury associated with PCL avulsion fracture[B-E], compound right ulna fracture[F], cerebral concussion, intra-abdominal injury and multiple lacerations establishing the distinctive of polytrauma. Results: The algorithm of DCO was resolute as treatment. Initial procedures of pelvic external fixation, right calcaneal traction, exploratory laparotomy, wound debridement and right long arm back-slab were done. CT pelvis and right knee performed after achieving initial fracture and hemodynamic stability. Internal fixations were applied after a period of time. The patient recovered after the DCO guided management with restoration of limb functional, and the quality of life greatly improved. Discussions: The DCO emphasizes the need to avoid further damage by the “second hit” which may originate from surgical procedures and focus on advanced life-saving supports.1 Our surgical team followed the principles of debridement and removal of the infection factors first, carried out definite surgery during the stable period. In addition to supply of the blood volume and protein, the nutritional support was emphasized. Conclusion: The DCO plays a pivotal role in the management strategies of complex pelvic ring injuries and floating knee with functional good outcome.