Pucker sign in irreducible posterolateral knee dislocation
Sanjiv Fitz-Morris Gray, Beatrice Esther Dieudonne
The Pan African Medical Journal. ;30:153. doi:10.11604/pamj..30.153.15365

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Images in clinical medicine

Pucker sign in irreducible posterolateral knee dislocation

Sanjiv Fitz-Morris Gray, Beatrice Esther Dieudonne
Pan Afr Med J. 2018; 30:153. doi:10.11604/pamj.2018.30.153.15365. Published 20 Jun 2018

A 24-year old male seen in the trauma bay involved in a motor vehicle accident with rollover landing on its roof. He was partially ejected with his right leg hyperflexed and entrapped. The patient was stable with complaints of right knee pain. There was dimpling of the right distal medial thigh (A, B). After unsuccessful attempts at closed reduction, the patient was taken for open reduction. There was entrapment of the femoral condyle in the extensor mechanism. The soft tissues were released and the condyle reduced back into its normal position. The extensor mechanism was then repaired. The patient had palpable posterior tibial and dorsalis pedis pulses after completion of the procedure. The mechanism for posterolateral knee dislocation is valgus and rotational stress during knee flexion. The medial cruciate ligament, anterior cruciate ligament, and the posterior cruciate ligament are usually injured in posterolateral knee dislocation with incarceration of the capsule and ligamentous structures in the intercondylar notch. Early open reduction is indicated as it is generally considered irreducible by closed reduction. The "pucker sign" is considered pathognomonic. On Radiographs with attention to the patella shows the patella maintaining its in-line attachments to the tibial tuberosity and is reduced with respect to the proximal tibia but dislocated with respect to the distal femur. At the follow up the patient is ambulatory after rehabilitation.

Corresponding author:
Sanjiv Fitz-Morris Gray, University of Central Florida College of Medicine Orlando, Florida, USA

©Sanjiv Fitz-Morris Gray et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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