Published online Jun 18, 2016. doi: 10.5312/wjo.v7.i6.401
Peer-review started: February 3, 2016
First decision: March 21, 2016
Revised: March 23, 2016
Accepted: April 7, 2016
Article in press: April 11, 2016
Published online: June 18, 2016
Posterolateral dislocations of the knee are rare injuries. Early recognition and emergent open reduction is crucial. A 48-year-old Caucasian male presented with right knee pain and limb swelling 3 d after sustaining a twisting injury in the bathroom. Examination revealed the pathognomonic anteromedial “pucker” sign. Ankle-brachial indices were greater than 1.0 and symmetrical. Radiographs showed a posterolateral dislocation of the right knee. He underwent emergency open reduction without an attempt at closed reduction. Attempts at closed reduction of posterolateral dislocations of the knee are usually impossible because of incarceration of medial soft tissue in the intercondylar notch and may only to delay surgical management and increase the risk of skin necrosis. Magnetic resonance imaging is not crucial in the preoperative period and can lead to delays of up to 24 h. Instead, open reduction should be performed once vascular compromise is excluded.
Core tip: Posterolateral knee dislocations are uncommon injuries that are often missed or misdiagnosed. We believe that attempts at closed reduction and preoperative magnetic resonance imaging are unnecessary delays to open reduction. We advocate emergent open reduction once vascular integrity is confirmed on ankle-brachial index testing.