Traumatic knee dislocation with ipsilateral tibia and fibula fractures is rare and complex, especially with patellar tendon rupture. We report a 47-year-old male with such injuries after a road accident. Despite severe trauma, popliteal artery flow remained intact, allowing staged management. Initial external fixation was followed by tibial nailing and patellar tendon repair using tension-relieving ethibond sutures. Delayed ACL and PCL reconstruction is planned. Vigilant vascular monitoring and systematic treatment are key for good outcomes.
Knee dislocations are rare, accounting for less than 0.02% of orthopedic injuries, but they are serious due to the risk of vascular injury, particularly to the popliteal artery. Ipsilateral fractures of the tibia and fibula occurring with knee dislocation are uncommon and complicate treatment. An associated patellar tendon rupture further increases complexity by preventing closed reduction. This report presents a rare injury combination and describes successful staged management, emphasizing preservation of vascular integrity and planned ligamentous reconstruction.
A 47-year-old male was involved in a road traffic accident on 26/08/2025 while riding a two-wheeler that collided with a four-wheeler. He had a history of seizure disorder managed with medication. On presentation, he was unconscious with a Glasgow Coma Scale score of E1VtM4, indicating severe head injury. His injuries included head trauma with subarachnoid hemorrhage, chest trauma with pneumothorax, and left lower-limb trauma with a puncture wound over the knee and deformity of the left leg.
Examination revealed palpable dorsalis pedis and posterior tibial pulses, suggesting intact distal circulation. X-rays demonstrated a knee dislocation with ipsilateral tibia and fibula fractures, an uncommon association.
Initial management prioritized stabilization of life-threatening injuries. Attempted closed knee reduction on day 0 failed due to a complete patellar tendon rupture, confirmed intraoperatively. An external fixator was applied for provisional stabilization. Vascular status was monitored, confirming maintained popliteal artery blood flow.
On day 2, the external fixator was removed. Intramedullary nailing of the tibial fracture was performed. The patellar tendon was repaired by suturing it to the tibial tuberosity with Ethibond sutures using a tension-relieving technique. This restored the extensor mechanism and allowed stable knee reduction.
The patient continues to be monitored with regular vascular checks. Delayed ligament reconstruction for the ACL and PCL is planned once the patient is medically stable.
Knee dislocations pose a high risk of popliteal artery injury, necessitating urgent and repeated vascular assessments. Despite severe trauma and complex fractures, this patient’s popliteal artery remained intact, allowing staged orthopedic intervention without vascular reconstruction.
The rarity of ipsilateral tibia and fibula fractures accompanying a knee dislocation creates challenges in both reduction and stabilization. Additionally, the complete rupture of the patellar tendon prevented initial closed reduction and required surgical repair. The use of Ethibond sutures with a tension-relieving technique successfully restored knee extension and stability.
Because ACL and PCL injuries frequently accompany knee dislocations, their assessment and reconstruction should be delayed until the patient has recovered from polytrauma, thereby minimizing surgical risk. A multidisciplinary approach is essential to optimize functional outcomes.
This case highlights the unusual and complex injury pattern of knee dislocation with ipsilateral tibia and fibula fractures and patellar tendon rupture. The critical factor was preservation of popliteal artery integrity, confirmed by repeated vascular examinations, which enabled a staged surgical approach. Early external fixation followed by fracture nailing and tendon repair, along with planned delayed ligament reconstruction, is an effective management strategy that may preserve limb function and support recovery in similar high-energy trauma cases.
Dr. Ismail 1st year resident, Kauvery Hospital, Alwarpet, Chennai.
