Posterior Cruciate Ligament Avulsion Fracture with Fibular Avulsion of Lateral Collateral Ligament-biceps Femoris Complex Avulsion Injury in Ipsilateral Diaphyseal Tibia Fracture - A Rare Complex Injury.

INTRODUCTION: Posterior cruciate ligament (PCL) avulsion fractures, lateral collateral ligament (LCL)-biceps femoris complex avulsion injuries are relatively uncommon injuries, and associated diaphyseal tibia fracture further is the rarest combination. It is challenging to diagnose such complex injuries, and missed injuries, particularly at the knee can lead to significant instability, increasing patients' morbidity. CASE REPORT: A 25-year-old male patient was diagnosed with PCL avulsion fracture, LCL - biceps femoris complex injury at the fibular side with Type I open mid-shaft both-bone leg fracture following a road traffic accident. Patient was operated with intramedullary nailing for tibia fracture on an emergency basis. Electively, the patient was managed with arthroscopic fixation of PCL avulsion fracture with pullout suture technique using two No. 2 fibre wires and secured at two locking screws of tibial nail without any further usage of fixation device on tibial surface. LCL - biceps femoris complex avulsion at fibular head was fixed back to the bone using two titanium double-loaded anchors. Patient was placed on a knee brace for 6 weeks. Knee range of movement was started at 3 weeks, allowing full range at 6 weeks. Partial weight bearing was allowed at 3 weeks and full weight bearing at 6 weeks. At 18-month follow-up, the patient showed complete recovery getting back to his routine. There was complete radiological union of all the fractures with an excellent functional score of 96 (Lysholm knee score). CONCLUSION: PCL avulsion fractures and LCL-biceps femoris complex avulsion injuries are serious injuries compromising knee stability significantly. Added with, ipsilateral tibia fracture makes the surgical decision very challenging. Therefore, it needs careful planning and a meticulous approach to attain complete functional outcome and to avoid complications.