title: Isolated posterior cruciate ligament injuries associated with closed tibial shaft fractures: a report of two cases.
abstract: BACKGROUND
  Knee ligament injuries associated with tibia shaft fractures are usually neglected and treatment is delayed. To our knowledge, no case presentation discusses the clinical result of closed tibial shaft fracture with concomitant ipsilateral isolated PCL injury. In this literature, we report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant PCL injury and discuss the treatment options.
  
  
  METHODS
  We report the clinical result of two cases that sustained closed tibial shaft fracture with concomitant posterior cruciate ligament (PCL) injury. Case 1 received open reduction with plate fixation for the tibial shaft fracture, and he also received arthroscopic reconstruction of PCL with bone-patellar tendon-bone graft due to neglecting PCL injury 5 months later after fracture fixation. Case 2 sustained left tibial-fibular shaft fracture with isolated PCL injury confirmed by magnetic resonance image on the first day of injury. She received tibia fixation with intramedullary nail and conservative treatment with bracing and rehabilitation for PCL injury.
  
  
  RESULTS
  In case 1, the male patient only focused on fracture healing without any knee rehabilitation. His knee flexed deeply for protected weight bearing in the injured leg which may have exacerbated the posterior instability and reduced the possibility of PCL healing. The end result of knee function was poor even though PCL reconstruction was done later. In case 2, the female patient with diagnosed posterior cruciate ligament injury on the day of injury, her knee was immobilized in brace with full extension, which improved PCL healing. In addition, she received rehabilitation of quadriceps strengthening, and hamstring muscle contraction was avoided in her daily activity. After rehabilitation, the female patient did not complain of severe subjective instability even with an obvious posterior translation on posterior drawer test.
  
  
  CONCLUSIONS
  We need to perform a careful physical examination of ipsilateral knee in cases of leg fractures, and MRI of knee before surgery if any doubt exists. However, a further research is needed to conclude on the best operation and rehabilitation program in patients with combined tibial shaft fracture and PCL injury.
authors.affiliation: Department of Orthopaedic Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. yuhan58@seed.net.tw
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Huang
authors.forename: Ping-Cheng
authors.initials: PC
authors.lastname: Liu
authors.forename: Sung-Hsiung
authors.initials: SH
authors.lastname: Chien
authors.forename: Pei-His
authors.initials: PH
authors.lastname: Chou
authors.forename: Cheng-Chang
authors.initials: CC
authors.lastname: Lu