A 16 year old boy was involved in a motorcycle RTA sustaining an APC type I injury to his pelvis and injuries to both lower limbs. A 10 cm laceration was found over his left adductor canal associated with a pulseless left leg and a 5 cm laceration over his right knee laterally.
After immediate resuscitation he was taken to theatre where he underwent debridement, washout and end to end contralateral long saphenous vein grafting to a severed femoral artery to his left leg. Left thigh fasciotomies were performed and a debridement and washout was then performed on his right knee laceration where a 5 cm retinacular tear was noted. A second look, further debridement and washout was performed at 48 hours and the right knee wound closed. At 7 days post injury split skin grafts were applied to the fasciotomy wounds.
Plain x-rays and a CT of the right knee revealed an undisplaced patella fracture. This was immobilised, and physiotherapy and rehabilitation began at 4 weeks post injury. He made an uneventful recovery from his pelvic and vascular injuries and was mobilising fully at 3 months.
He subsequently presented to a knee surgeon 6 months later with a history of mechanical locking in his right knee. An arthroscopy was performed using standard portals and a 10 mm soft drink bottle cap was found in the intercondylar notch anterior to the ACL (Figure 1). This was removed through the medial portal. The rest of the joint was normal with no osteochondral defects and the patella fracture had healed. He made a full recovery with complete resolution of his locking symptoms.Source: Google Knol Boyle et al. Cases Journal 2010 3:72 (Distributed under the terms of the Creative Commons Attribution License.)