European Journal of Trauma Ab stractTraumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and gracilis transfer were done. Case StudyA 65-year-old man, when walking in the street, was involved in a motor vehicle accident 3 weeks previously. He described a valgus and internal rotation force to his right knee. After falling to the ground, he was unable to weight bear on his right knee. Initially, the patient was seen at the state hospital in another city and according to medical records his right knee remained dislocated despite reduction attempts by closed means. The patient was admitted to our hospital with a 21-day delay. The right knee was noted to have a gross S-shaped deformity with the tibia dislocated posterior to the femoral condyles. The right medial femoral condyle was prominent under the skin, and a dimple sign, an invagination of medial tissues located anteriorly between the medial femoral condyle and medial tibial plateau, was seen on the ecchymotic skin (Figures 1a and 1b). The patella was dislocated laterally. Ligamentous stability could not be assessed, since the knee was locked in 30° flexion. The right dorsalis pedis and posterior tibial arteries were pulsatile. Sensation and motor function of the right leg and foot were intact. Radiographs of right knee showed marked medial joint space widening with posterolateral translation of the proximal tibia and patella dislocation laterally (Figures 2a to 2c). Despite difficulties obtaining appropriate and sufficient views because of discomfort of patient, MRI showed incarceration of the medial collateral ligament (MCL) and rupture of both cruciate ligament ( Figure 3). Angiography of his right lower extremity was normal (Figure 4). He had ipsilateral both rami pubis fractures and a contralateral minimally displaced transverse distal third tibia fracture. A long-leg cast had been applied before. In his systemic examination, he had partial visual impairment and headache. CT examination revealed a minimal subdural hematoma which did not require surgical intervention by the consultant neurosurgeon. After clinical and radiologic e...

Conclusion:As seen in our large series study, PNL is a highly effective and safe procedure that can be applied to the obese patients.