A Rare Case Report: Managing PCL Avulsion Fracture with a Fracture of the Proximal Tibial Shaft
Authors:   Department of Orthopaedics, SN Medical College, Agra, Uttar Pradesh, India, Goyal Amrit , Vimal Yuvraj ,   Department of Orthopaedics, SN Medical College, Agra, Uttar Pradesh, India, Mittal Vivek ,   Department of Orthopaedics, SN Medical College, Agra, Uttar Pradesh, India, Gupta Mayur ,   Department of Orthopaedics, SN Medical College, Agra, Uttar Pradesh, India, Kapoor Rajat ,   Department of Orthopaedics, SN Medical College, Agra, Uttar Pradesh, India, Rohela Ravikant ,   Department of Orthopaedics, SN Medical College, Agra, Uttar Pradesh, India
Published: January 2025

Introduction: Posterior cruciate ligament (PCL) avulsion fractures of the tibia with ipsilateral tibial shaft represent a rare but challenging orthopedic injury, necessitating careful consideration of surgical interventions for optimal outcomes. This case report presents the successful management of tibial shaft fracture (proximal 1/3rd junction) along with ipsilateral PCL avulsion fracture of tibia using a novel approach using open reduction internal fixation (ORIF) of tibial shaft with Locking compression plate (LCP) with cannulated cancellous screw and spiked washer fixation of PCL avulsion. There are no case reports or research articles available for the management of PCL avulsion fracture of tibia associated with ipsilateral tibial shaft fracture.

Case Report: The patient, 34-year old male, presented with significant pain, swelling, and limited range of motion following a road traffic accident. Radiographic evaluation revealed a comminuted fracture proximal tibia and fibula with PCL avulsion fracture of the tibia, prompting a comprehensive surgical intervention. We planned to manage both fractures in a two-stage surgery. The selected approach involved ORIF of the proximal tibia fracture by utilizing LCP, followed by open reduction and internal fixation of PCL avulsion using cannulated cancellous screws, supplemented by the innovative application of a spiked washer for enhanced stability. Patients underwent monthly follow-ups during the initial 3 months. During each follow-up, both clinical and radiological assessments were conducted. Clinical evaluations focused on stability and range of motion (ROM), employing a drawer test for stability assessment. Radiological evaluations were based on the union shown in X-rays. The follow-up duration was up to 6 months, culminating in the calculation of the final functional outcome using the Lysholm knee scoring system.

Conclusion: This case report contributes valuable insights into the successful management of PCL avulsion fractures associated with ipsilateral tibial shaft fracture, emphasizing the importance of customized surgical techniques and the utilization of advanced fixation devices. The presented approach with cannulated cancellous screws and a spiked washer showcases a promising option for achieving stable fixation and promoting efficient healing in such challenging cases. Further, research and long-term studies are warranted to validate the efficacy and durability of this innovative surgical method.

Keywords: Posterior cruciate ligament avulsion, spiked washer fixation, novel technique, internal fixation.