Presentation
Motor vehicle collision. Right femoral fractures in external traction with absent peripheral pulses ?vascular injury.
Patient Data
Open comminuted fracture through the right distal femoral metadiaphysis extending to the patellofemoral joint. Vertically oriented patellar fracture. Posterior lateral tibial plateau fracture involving the posterior aspect of the intercondylar area, likely representing a PCL avulsion fracture.
Pneumolipohaemarthrosis. Right thigh and upper calf are swollen.
No gross arterial injury identified with small caliber but patent vessels and three-vessel run-off to the level of the ankle. Right common femoral, profunda femoris and popliteal arteries are of irregular caliber throughout, without intimal flap, most likely reflecting vasospasm.
Zoomed CT images demonstrated presence of blood, fat and gas making a pneumolipohaemarthrosis.
Case Discussion
Lipohemarthrosis in the knee is indicative of an intra-articular injury with addition of intra-articular gas making a pneumolipohaemarthrosis, which indicates the fracture is open (compound).
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