PCL

AVULSION
INJURES
NEY DA ONNEY (P1337430116053/1A)
Abstract
Avulsion fractures of the posterior cruciate ligament
(PCL) are uncommon. On the other hand, avulsion
fractures of the tibial condyle are also rare. In this
case reports a PCL-mediated avulsion fracture of
the lateral tibial condyle along with the tibial
insertion of the PCL. This rare case may imply that
application of an extension-distraction force to the
PCL cause the avulsion fracture.
Introduction
Avulsion fractures of the posterior cruciate ligament
(PCL) are uncommon. A few mechanisms of PCL
injures have been proposed on the basis of the site
of damage of the PCL. Herein, we report a PCL-
mediated avulsion fracture of the lateral tibial
condyle along with the tibial insertion of the PCL by a
mechanism that, to the best of our knowledge, has not
been previously described in any study.
Genu
Anatomy of Genu
Pathology of Genu
Fracture
Avulsion
Fusion
Lesion
dislocation
Case Presentation
A 33-year-old male foresty worker sustained an
injury to his right knee. While he was climbing a
steep hill, a rolling log hit the anterior aspect of
the extended knee. At this time, his right lower leg
was pulled down and extended forcibly by the
rolling log, and he experienced immediate pain,
swelling of the knee, and inability to bear weight
on the right on the right leg.
On clinical examination,we found that he had
significant effusion in the affected knee. He
complained of pain in the knee, especially during
active and passive extension of the knee.

Radiographs revealed fractures of the posterior

intercondylar eminence and the lateral tibial
condyle.
MEDICAL PROCEDURES

The radiographic examination was arranged to

showing the radiographs that revealed fractures of
the posterior intercondylar eminence and the
lateral tibial condyle.
There are two projection on examination that are
anterior-posterior projection and medio-lateral
projection.
Preparations

Examines the radiographic room and

cleans/straightens it before escorting the patient in.
Has all equipment and supplies (patient gown, shield,
markers, lead blockers, etc.) readily available before
escorting the patient in.
Is able to manipulate all radiographic equipment with
ease, and centers the central ray to the
cassette/receptor for all projections.
Adjusts the tube to the proper SID for each projection.
Selects cassettes/receptor of the appropriate sizes for
all projections, according to patient size and
examination.
PATIENT PREPARATION
Identifies the correct patient and examination according to
the requisition while establishing a good rapport with him or
her.
Obtains and documents the patients history before the
examination.
Explains the examination in terms the patient fully
understands and properly communicates with the patient
throughout the examination.
Asks female patients of childbearing age the date of their
last menstrual period and documents this; inquires about the
possibility of pregnancy and has them sign pregnancy
consent forms.
Removes all obscuring objects (shoes, zippers, belts, etc.) so
as not to produce radiographic artifacts.
 Patient Positioning
Centers the central ray
Anterior-Posterior perpendicularly (or angles it 5
Projection 7 cephalad) to a point
approximately 1/2 inch below
the patellar apex.
Instructs the patient to extend
the knee as much as possible.
Places the posterior surface
of the knee in contact with
the radiographic table and
internally rotates the leg
while checking that the
femoral epicondyles are
parallel to the
cassette/receptor.
 Patient Positioning
Lateral (Medio-
lateral) Projection
Centers the central ray
perpendicularly to the knee joint
at a point approximately 1/2
inch below the patellar apex.

Rotates the entire leg

45 medially/internally.
Elevates and supports
the affected hip.
Centers the anatomy of
interest to the center of
the cassette/receptor.
Discussion
This case report describes an unusual PCL-mediated
avulsion fracture of the lateral tibial condyle. This
injury may be different from other reported PCL
injuries.
In this case, a fragment of the lateral tibial condyle
was avulsed anterosuperiorly along with the
fragment of the tibial insertion of the PCL. Avulsion
fractures of the posterolateral tibial condyle are
rare because there is no muscle insertion on the
posterior aspect of the lateral tibial condyle.
 PCL injuries usually occur at the femoral origin,
in the substance, and at the tibial insertion of the
PCL. Three possible mechanisms for PCL injuries
have been proposed as allows: hyperflexion,
dashboard injury, and hyperextension.
However, the mechanism of injury in this case did
not correspond to any of the above mechanisms
from the perspective of the relationship of the
mechanism to the site of damage.
 With regard to the treatment, non-operative
treatment was another choice
The knee hyperextension showed a general
injury pattern to the posteolateral corner and
no gross posterior cruriate ligament injuries.
The distraction force to be more dominant than
the hyperextension force in this case because
the PCL was injured but not the posterior
capsule.
 The PCL can tolerate a distraction force that is
strong enough to avulse the lateral tibial
condyle if the surface area of the tibial
insertion site and the substance of the PCL are
significantly wider.
The posterior approach was a better
alternative than arthroscopic surgery in this case
because of the complex fracture pattern of the
tibial insertion of the PCL.
 Conclusion

PCL injury patterns are complex and are related to

diverse mechanisms of injury and to the structure of
the PCL. This rare case may imply that application
of an extension-distraction force to the PCL may
cause avulsion fracture of the lateral tibial condyle.
Refference
Biedrzycki, Anita. Radiography Procedure and
Competency Manual Ed.2. United Stated of
America: F.A. Davis Company, 2008.
http://simphealth.com/id/pages/1661766

http://pubs.rsna.org/doi/abs/10.1148/rg.28

6085503
Thank You