Dislocation and fracture-dislocation of the knee are serious injuries, often related to high-energy trauma. Irreducibility with closed techniques is an extremely rare and challenging problem that has been described in posterolateral, posterior and lateral knee dislocations. Irreducibility in fracture-dislocations around the knee has only been described twice in the literature and never in association with a tibial plateau fracture. We report a unique case of an irreducible tibial plateau fracture-dislocation in which closed reduction was prevented by incarceration of the medial meniscus within the fracture site. The patient required transfer to our institution due to a concomitant traumatic brain injury. This contributed to a delay of 10 hours from injury to arrival in our resuscitation room. Progressive swelling and absent foot pulses resulted in immediate transfer to the operating theater where open reduction and internal fixation was performed with four-compartmental fasciotomies. The patient made a rapid and full recovery. Where closed techniques have failed, open reduction must then be undertaken in order to prevent the devastating complications of compartment syndrome and neurovascular compromise.

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