Type:
Educational Exhibit
Keywords:
Bones, Musculoskeletal joint, Musculoskeletal system, CT, MR, Education, Trauma
Authors:
K. Singh, P. Jeremic, S. Singh
DOI:
10.26044/ranzcr2022/R-0163
Imaging findings OR Procedure details
Patient 1: A 28 year-old male patient presenting to the emergency department with a swollen knee with inability to weightbear following a high axial load injury whilst playing a soccer competition. Clinical examination by the emergency team demonstrated a markedly swollen right knee which was neurovacularly intact at time of clinical assessment. There was concern of knee joint (tibiofemoral) dislocation at time of history taking. On examination, the patient was globally tender over the knee with more tenderness along the lateral joint line. The patient was non compliant with clinical examination due to pain, which was addressed with IV fentanyl. The vital signs were within normal limits with no concern systemic haemodynamic compromise or instability. A radiograph was performed which demonstrated a fracture of the fibular head. This was folllowed by a CT angiogram of the right knee to exclude popliteal artery transection and subsequently an MRI which revealed posterolateral corner injury and further injuries to the right knee. The imaging findings and traumatic sequalae are discussed in the image description. The patient had operative management for their injuries.
Patient 2: A 33 year old patient endured a motor vehicle collision during an accident whilst travelling on a motorcycle at 85km/h. A full body CT was performed which revealed no intracranial, cervical or abdominopelvic pathology with rib fractures detected in the right 3rd-8th ribs at the site of intact. The patient was haemodynamically intact with some pain on inspiration and unable to weightbear completely on both limbs. A radiograph, CT and MRI was performed over the next few days in hospital. Initially, the left knee was imaged on a 1.5T MRI with the second knee imaged the following day on a 3T MRI due to availability. The imaging findings are patient findings are discussed in the image description below. The patient had operative managmement for their injuries.
Intra-operative findings:
Patient 1
Right Knee
1. Tibial spine and anterior condyles fractures.
2. Arcuate ligament complex rupture.
3. High grade PFL interstitial tear.
4. Interstitial tear of the ACL.
Patient 2:
Right Knee:
1. Rupture of the ACL
2. Apical tear of the medial meniscus poterior horn.
3. Meniscocapsular sprain.
4. Avulsion fractures at the anterior and posterior root attachments.
5. FCL partial thickness tear.
6. Common peroneal nerve injury.
Left knee:
1. Lateral tibial plateau fracture.
2. Fracture of the terminal sulcus.
3. Ruptured MCL
4. PLC injury with LCL interstiital tear, Biceps femoris intersitital tear and lateral meniscal tear.