title: Open reduction and internal fixation of isolated PCL fossa avulsion fractures.
abstract: OBJECTIVE
  The study was aimed to share the experience of managing posterior cruciate ligament (PCL) avulsion fractures of tibia with open reduction and internal fixation (ORIF). The study also evaluated the effect of delay in treatment and presence of occult PCL injury on the final outcome after surgery.
  
  
  METHODS
  Forty-two patients (30 males and 12 females) with a median age of 26 years (range: 14-53 years) who underwent ORIF through a modified posterior approach for PCL fossa avulsion fractures were assessed after a median follow up of 18 months (range 10-42 months). In 30 patients surgery was performed within 3 weeks of injury. Fifteen patients had an occult intrasubstance PCL tear as seen on MRI. Assessment of results was made using Hughston criteria.
  
  
  RESULTS
  There was a statistically significant difference in the outcomes between acutely treated patients and patients with chronic injury. Although patients with acute fixation were found to fare better, the results were fair or good in majority of the patients (9 out of 12) with delayed presentation. Patients with occult injury to PCL had poorer outcomes and these results were found to be statistically significant.
  
  
  CONCLUSIONS
  ORIF for PCL avulsion fractures of tibia results in stable fixation, early mobilization and good functional outcomes. Although ORIF done acutely leads to best clinical outcomes, a delay in presentation (>3 weeks) does not necessarily contraindicate ORIF. An occult injury to PCL usually leads to inferior outcomes and primary PCL reconstruction should be considered as a viable option in these patients.
authors.affiliation: Department of Orthopedic Surgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India. kamalpgi@gmail.com
authors.forename: Kamal
authors.initials: K
authors.lastname: Bali
authors.forename: Sharad
authors.initials: S
authors.lastname: Prabhakar
authors.forename: Uttam
authors.initials: U
authors.lastname: Saini
authors.forename: M S
authors.initials: MS
authors.lastname: Dhillon
mesh_terms: D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007718:Knee Injuries / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016119:Posterior Cruciate Ligament / Q000293:injuries* / Q000601:surgery; D020127:Recovery of Function; D012189:Retrospective Studies; D013978:Tibial Fractures / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult