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Dawood MH, Shahzad MG, Perveen H, Daniyal M, Sohail S, Roshan M. Incidence and characteristics of ligamentous knee injuries accompanying a femur shaft fracture and their association with injury mechanism and fracture characteristics: A prospective-observational study in a low-middle-income country. SAGE Open Med 2024; 12:20503121231222822. [PMID: 38264408 PMCID: PMC10804903 DOI: 10.1177/20503121231222822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/07/2023] [Indexed: 01/25/2024] Open
Abstract
Objective This study aims to elaborate the incidence, types, and characteristics of ligamentous knee injuries accompanying femoral-shaft fractures and their association with demographic data, fracture characteristics, and injury mechanism. Methods This multi-center-prospective-observational study examined patients in the Shaheed Mohtarma Benazir Bhutto Institute of Trauma and Civil Hospital orthopedic wards. Using the consecutive sampling technique, 146 patients with femoral-shaft fractures were recruited, and scrutinized to determine the presence of ligamentous knee injury, through an evaluation form encompassing patients' demographic data, fracture characteristics, knee examinations, and confirmed through magnetic resonance imaging. Knee injuries were detected intra-operatively under regional/general anesthesia and post-operatively utilizing diagnostic maneuvers (varus/valgus stress, Lachman, anterior/posterior drawer, external rotation recurvatum, and McMurray tests) by 2-3 surgeons and confirmed through magnetic resonance imaging. Magnetic resonance imaging was exclusively employed in suspected false positive/negative cases, and when a titanium implant was utilized, that is, 131 cases (89.7%). Chi-square test was used to assess the relationship between incidence and type of ligamentous knee injury with demographic data, injury mechanism, and fracture characteristics. Results Among the 146 patients with femoral-shaft fractures, 78% and 22% were males and females, with 37% experiencing associated ligamentous knee injury. Medial collateral ligament and anterior cruciate ligament were the commonest types of ligamentous injuries accompanying femoral-shaft fractures, at 44% and 33%. The Chi-square revealed a statistically significant association between the incidence of ligamentous knee injury accompanying femoral-shaft fracture with demographic data, injury mechanism, and fracture characteristics (p-value < 0.05), and was noted to be higher among males (55.6%), participants aged 18-25 years (66.7%), involved in a road traffic accident (88.9%), resulting in a complex (77.8%) and close fracture (88.9%). A similar association was seen between medial collateral ligament and anterior cruciate ligament injuries with age, injury mechanism, and fracture characteristics (p-value < 0.05). Conclusion Our study revealed the unaddressed fact that Pakistan has a significant incidence of ligamentous knee injuries accompanying femoral-shaft fractures. These insights can empower clinicians/surgeons to understand and manage this condition effectively.
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Affiliation(s)
- Muhammad Hamza Dawood
- United Medical and Dental College, Affiliated with Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Gulfam Shahzad
- Trauma Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan
| | - Haseefa Perveen
- United Medical and Dental College, Affiliated with Jinnah Sindh Medical University, Karachi, Pakistan
| | - Muhammad Daniyal
- United Medical and Dental College, Affiliated with Jinnah Sindh Medical University, Karachi, Pakistan
| | - Sheza Sohail
- United Medical and Dental College, Affiliated with Jinnah Sindh Medical University, Karachi, Pakistan
| | - Mavra Roshan
- United Medical and Dental College, Affiliated with Jinnah Sindh Medical University, Karachi, Pakistan
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MRI of the Knee Meniscus. Magn Reson Imaging Clin N Am 2022; 30:307-324. [DOI: 10.1016/j.mric.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Rollo G, Falzarano G, Ronga M, Bisaccia M, Grubor P, Erasmo R, Rocca G, Tomé-Bermejo F, Gómez-Garrido D, Pichierri P, Rinonapoli G, Meccariello L. Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years. Injury 2019; 50 Suppl 4:S30-S38. [PMID: 30910244 DOI: 10.1016/j.injury.2019.03.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Floating knee is a flail knee joint resulting from fractures of the shafts or adjacent metaphyses of the femur and the ipsilateral tibia. It is usually associated with several complications and mortality. This study was designed to present our experience with the treatment of this injury. MATERIAL AND METHOD This study was performed between January 2004 and December 2014. 224 cases of floating knee injuries gathered from the 34,480 lower extremities trauma files were studied, and the target information recorded. The injuries most frequently occurred in subjects between 16 and 35 years of age (60.71%), and in male subjects (85.71%). The most frequent mechanism of injury was traffic accident (92.85%). External fixation was the common type of treatment (82.14%) in emergency or as a definitive treatment. The treatment was performed within 24 h of the trauma. We performed a 36-month follow up with clinical examination, radiographs, assessing the complications, and using the Modified Cincinnati Rating System Questionnaire (MCRSQ) and the Karlström/Olerud Score (KOS) to evaluate the progression of the outcomes. RESULTS Early complications included 8 cases of compartment syndrome, 60 open fractures and 24 partially amputated limbs. A total amputation was performed in 3 patients. The most common late complication was heterotopic calcifications of the knee (n = 68, 30.6%). Good scores for MCRSQ and KOS were obtained only after patients were sent to a reference center for knee surgery. CONCLUSIONS Our experience revealed that the complication rate associated with floatingknee injuries remains high, regardless of the performed treatment. Surgeons should focus on reducing complications while treating these severe injuries.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Mario Ronga
- Department of Medicine and Health Sciences 'Vincenzo Tiberio' University of Molise, Campobasso, Italy
| | - Michele Bisaccia
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Predrag Grubor
- Clinic of Traumatology, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Rocco Erasmo
- Department of Orthopedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Guido Rocca
- Department of Orthopedics and Traumatology, Trauma Center "Pietro Cosma", Camposampiero, PD, Italy
| | - Felix Tomé-Bermejo
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - David Gómez-Garrido
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Rollo G, Falzarano G, Ronga M, Bisaccia M, Grubor P, Erasmo R, Rocca G, Tomé-Bermejo F, Gómez-Garrido D, Pichierri P, Rinonapoli G, Meccariello L. WITHDRAWN: Challenges in the management of floating knee injuries: Results of treatment and outcomes of 224 consecutive cases in 10 years. Injury 2019; 50:453-461. [PMID: 30563714 DOI: 10.1016/j.injury.2018.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 02/02/2023]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in Injury, 50(2) (2019) 453–461, https://doi.org/https://doi.org/10.1016/j.injury.2018.12.009. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Giuseppe Rollo
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Gabriele Falzarano
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Gaetano Rummo", Benevento, Italy
| | - Mario Ronga
- Department of Medicine and Health Sciences 'Vincenzo Tiberio' University of Molise, Campobasso, Italy
| | - Michele Bisaccia
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Predrag Grubor
- Clinic of Traumatology, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Rocco Erasmo
- Department of Orthopedics and Traumatology, Santo Spirito Hospital, Pescara, Italy
| | - Guido Rocca
- Department of Orthopedics and Traumatology, Trauma Center "Pietro Cosma", Camposampiero, PD, Italy
| | - Felix Tomé-Bermejo
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - David Gómez-Garrido
- Orthopaedic and Traumatology Unit, Hospital General de Villalba, Madrid, Spain
| | - Paolo Pichierri
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy
| | - Giuseppe Rinonapoli
- Department of Orthopedics and Traumatology, Azienda Ospedaliera "Santa Maria della Misericordia", Perugia, Italy
| | - Luigi Meccariello
- Department of Orthopedics and Traumatology, Vito Fazzi Hospital, Lecce, Italy.
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Incidence and risk factors of knee injuries associated with ipsilateral femoral shaft fractures: A multicentre retrospective analysis of 429 femoral shaft injuries. Injury 2018; 49:1602-1606. [PMID: 29887503 DOI: 10.1016/j.injury.2018.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 05/26/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
A femoral shaft fracture is usually a high-energy injury and, thus, is likely to be accompanied by an injury of adjacent joints such as a knee ligament injury. However, these associated injuries are often neglected because of severe pain and deformity. The purpose of the current study is to evaluate the incidence, type and risk factors of ipsilateral knee injuries associated with femoral shaft fractures. A total of 429 femoral shaft fractures were included in this study from January 2010 to September 2015. There were 320 males and 109 females, with mean age of 40.7 years (range, 15-88). Exclusion criteria were skeletally immature patients and patients with metabolic bone disease such as osteoporosis, atypical femoral fractures, and pathologic fractures. The incidence and type of knee injury were identified, and the injury mechanisms, AO/OTA classification of the femoral shaft fractures, were analysed for assessment of risk factors for knee injuries combined with femoral shaft fractures. Knee injuries were found in 131 cases. Knee ligament injuries were identified in 87 cases. There were 20 posterior cruciate ligament injuries, 11 anterior cruciate ligament (ACL) injuries, 16 medial collateral ligament (MCL) injuries, 8 lateral collateral ligament (LCL) injuries, and 32 multi-ligament injuries. In 24 cases, ligament injuries were not detected before internal fixation of femoral shaft fractures. Average time of diagnosis for ligament injury after fixation in these neglected cases was about 10.6 weeks (range, 1-32). Fractures around the knee joint were identified in 69 cases; there were 32 patellar fractures, 14 distal femoral intra-articular fractures, 14 tibia plateau fractures, 3 proximal fibular fractures, and 6 combined fractures. Male sex, type C fracture of AO/OTA classification, and motor vehicle accidents were identified as risk factors for associated ipsilateral knee injuries in femoral shaft fractures. Knee injuries were identified in approximately 30% of femoral shaft fractures. About 30% of ligament injuries were not detected before internal fixation of femoral shaft fractures. Care should be taken since knee injuries can be accompanied by ipsilateral femoral shaft fractures.
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Yoon YC, Jeon SS, Sim JA, Kim BK, Lee BK. Concomitant posterior cruciate ligament injuries with direct injury-related patellar fractures. Arch Orthop Trauma Surg 2016; 136:779-84. [PMID: 27034237 DOI: 10.1007/s00402-016-2449-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Posterior cruciate ligament (PCL) injuries and direct injury-related patellar fractures have similar causative factors. However, the mechanisms underlying these injuries differ. We aimed to evaluate the incidence and relationship between PCL injuries and direct injury-related patellar fractures. MATERIALS AND METHODS Of the 195 patients diagnosed with a patellar fracture at our clinic during 2007-2011, 104 required surgical treatment and underwent the posterior drawer test under general anesthesia and magnetic resonance imaging. We assessed whether the causes of trauma, fracture classification, compression of the fracture fragment, and fracture displacement were related to the incidence of PCL injuries. RESULTS Of the 104 patients, 26 had concomitant PCL injuries with direct injury-related patellar fractures. Most of the PCL injuries were grades 1 and 2, observed in 14 and 9 patients, respectively. Among three patients with grade 3 PCL injury, only two required PCL reconstruction. No significant relationship was observed between the causes of trauma and the incidence of PCL injury. According to the fracture classification, lower pole and comminuted fractures were associated with higher incidence rates of PCL injury than transverse and vertical fractures. Compressed and displaced patellar fractures were also associated with higher incidence rates of PCL injury. CONCLUSION Although a PCL injury requiring surgical intervention was extremely rare, 25 % patients who required surgery for patellar fractures presented with a PCL injury. The incidence of a PCL injury was higher in the lower pole, comminuted, displaced, and compressed patellar fractures.
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Affiliation(s)
- Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gacheon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760, Korea
| | - Sung-Soo Jeon
- Department of Orthopaedic Surgery, Gacheon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760, Korea
| | - Jae-Ang Sim
- Department of Orthopaedic Surgery, Gacheon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760, Korea.
| | - Byung-Kag Kim
- Department of Orthopaedic Surgery, Gacheon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760, Korea
| | - Beom-Koo Lee
- Department of Orthopaedic Surgery, Gacheon University Gil Hospital, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 405-760, Korea
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Kumar B, Borgohain B, Balasubramanian S, Sathyanarayana V, Muthusamy M. Risks of concomitant trauma to the knee in lower limb long bone shaft fractures: A retrospective analysis from a prospective study population. Adv Biomed Res 2014; 3:49. [PMID: 24627857 PMCID: PMC3949338 DOI: 10.4103/2277-9175.125764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 07/14/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Numerous associated injuries (bony and/or soft tissue lesions) occur commonly in conjunction with fractures of the femoral shaft in young patients after high-energy injuries. Knee ligamentous injuries, historically called as the internal derangements of the knee or IDK, are mostly not visible in plain radiographs taken in the emergency and these injuries are likely to be overlooked by clinicians because first attention always goes to open wounds and radiologically visible injuries of the limb whenever a patient is received in a trauma unit. MATERIALS AND METHODS A total of 93 cases of lower limb long bone fractures were retrospectively analyzed from materials of a prospective study conducted on consecutive patients having high-velocity injuries to lower limb long bones with a view to confirm or rule out concomitant ipsilateral IDK in cases of femoral and tibial shaft fractures, that already employed a policy of focused clinical examination followed by arthroscopy of the ipsilateral knee, immediately after operative fracture fixation under the same anesthesia. The goal was to determine the incidence of concomitant internal derangement of the ipsilateral knee and to understand any value of adding arthroscopy to detect concomitant IDK in lower limb long bone fractures besides careful intraoperative examination to propose a recommendation thereof. RESULTS Concomitant knee injury was found in 14 femoral fractures and 1 tibial fracture. Fifteen out of 93 (16%) such cases had concomitant knee ligamentous or meniscal injures. A total of 13 anterior cruciate and 4 posterior cruciate tears, 11 collateral ligament tears, and 10 meniscal injuries were confirmed in these 15 knees. Femoral shaft fractures were associated with a high incidence of serious ligamentous, meniscal, and chondral injury. Twelve out of 41 femoral fractures had chondral injuries (contusion), especially of the patello-femoral articulation, identifiable during arthroscopy. CONCLUSION One should have high index of suspicion about internal knee injuries and capsule-ligamentous injuries while dealing with femoral shaft fractures in particular. Arthroscopy of knee may safely enhance the diagnosis of simultaneous IDK. We propose that when MR imaging is not possible and when contraindication for arthroscopy does not exist, a careful clinical examination followed by arthroscopy of the knee may be considered a useful adjunct in femoral shaft fractures as it can readily confirm IDK by its ability to objectively look, probe, and distinguish fragile tissue from a normal one. Further study in larger number of subjects is needed to validate our findings.
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Affiliation(s)
- Brajesh Kumar
- Department of Orthopaedics, Meenakshi Mission Hospital and Research Centre. Lake Araea, Melur Road. Madurai, Tamil Nadu, India
| | - Bhaskar Borgohain
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India
| | - S Balasubramanian
- Department of Orthopaedics, Meenakshi Mission Hospital and Research Centre. Lake Araea, Melur Road. Madurai, Tamil Nadu, India
| | - V Sathyanarayana
- Department of Orthopaedics, Meenakshi Mission Hospital and Research Centre. Lake Araea, Melur Road. Madurai, Tamil Nadu, India
| | - M Muthusamy
- Department of Orthopaedics, Meenakshi Mission Hospital and Research Centre. Lake Araea, Melur Road. Madurai, Tamil Nadu, India
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Concomitant ligamentous and meniscal knee injuries in femoral shaft fracture. J Orthop Traumatol 2013; 15:35-9. [PMID: 23880786 PMCID: PMC3948523 DOI: 10.1007/s10195-013-0255-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 07/09/2013] [Indexed: 12/30/2022] Open
Abstract
Background Concomitant knee injury is a common finding in femoral fractures but can be easily missed during early management of the initial trauma. Degrees of damage to the articular structures vary considerably; from only a mild effusion to complete ligamentous and meniscal tears. Since previous reports were mostly from developed societies, this study was designed to look into characteristics of associated knee injury in a sample from Iran, to represent a developing country perspective. Materials and methods Consecutive patients admitted to an orthopedic ward of Baqiyatallah hospital (Tehran, Iran) with diagnosis of femoral fracture were enrolled in this study between October 2008 and September 2009. In patients who met the inclusion criteria of the study, arthroscopic or open surgical examination of the knee, ADT, Lachman test, varus and valgus stress tests under anesthesia were carried out to determine the incidence of knee injury. Results Forty patients with ipsilateral and two patients with bilateral femoral fractures were studied. Arthroscopy revealed medial meniscus injury in 12 (27 %) knees. Three (7 %) lateral meniscus injuries, 18 (40.9 %) ACL injuries and 2 (4.5 %) PCL injuries were also found. In varus and valgus stress tests, 15 (34 %) MCL and 4 (9 %) LCL laxities were noticed. The Lachman test was positive in 3 (6 %), and ADT was positive in 2 (4.5 %) patients. Conclusions Based on our observations, concomitant ligamentous and meniscal knee injury is a common finding in femoral shaft fractures and rates of these injuries are generally in concert with reports from developed nations.
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Kim JG, Lim HC, Kim HJ, Hwang MH, Yoon YC, Oh JK. Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients. Arch Orthop Trauma Surg 2012; 132:1741-6. [PMID: 22926737 DOI: 10.1007/s00402-012-1605-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to report the frequency with which posterior cruciate ligament (PCL) injuries occurred in combination with peri-articular fractures around the knee, and to determine the frequency with which the detection of these PCL injuries was delayed (i.e., detected in an outpatient clinic after fracture treatment). METHODS This retrospective study included 448 subjects with peri-articular fractures around the knee, including femoral shaft fractures, distal femoral fractures, patellar fractures, tibial plateau fractures, and tibial shaft fractures. The PCL injuries were detected through clinical examination, magnetic resonance imaging, and stress X-rays. We determined both the frequency of PCL injuries that occurred in combination with peri-articular fractures around the knee, and the frequency with which the detection of these PCL injuries was delayed. We also compared the frequency with which PCL injuries were associated with either isolated or combined fractures for different fracture types. RESULTS We identified concomitant PCL injury and peri-articular fracture of the knee in 7.8 % of patients. In 22 of the 35 patients with concomitant PCL injury, the detection of the PCL injury was delayed. There were significant differences in the frequency with which PCL injuries were associated with isolated or combined fractures of the femoral shaft (P = 0.04), patella (P = 0.03), and distal femur (P = 0.03). CONCLUSION The delayed detection frequency was high for PCL injury after peri-articular fracture around the knee.
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Affiliation(s)
- Jae Gyoon Kim
- Department of Orthopedic Surgery, Korea University College of Medicine, Korea University Guro Hospital, 97, Gurodong-Gil, Guro-Gu, Seoul 152-703, Republic of Korea
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Atypical clinical presentation of periprosthetic femur fracture after revision total hip arthroplasty. Am J Phys Med Rehabil 2010; 89:772-5. [PMID: 20531152 DOI: 10.1097/phm.0b013e3181e2d22d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A common complication after revision total hip arthroplasty is periprosthetic fracture. These injuries tend to occur in bones that have undergone repeated reaming during surgery, thereby compromising the intramedullary integrity of the bone. The clinical presentation of this complication varies among patients, and practitioners must use clinical suspicion and imaging studies to make the diagnosis early. This case study presents a patient who sustained a periprosthetic femur fracture and reported isolated knee pain. This obscure clinical presentation delayed the patient's diagnosis, which could have potentially led to further mobility. This report stressed the importance of taking an accurate history and physical examination as well as using diagnostic modalities when appropriate.
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Comparison of knee function after antegrade and retrograde intramedullary nailing for diaphyseal femoral fractures: results of isokinetic evaluation. J Orthop Trauma 2009; 23:640-4. [PMID: 19897985 DOI: 10.1097/bot.0b013e3181a5ad33] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate knee function in patients having femoral diaphyseal fractures treated with antegrade or retrograde intramedullary nail insertion. DESIGN Prospective. SETTING Level I referral center. PATIENTS AND METHODS Seventy patients having 71 OTA 32 fractures were randomly allocated into 2 groups to be treated with either antegrade or retrograde intramedullary nails inserted with reaming. INTERVENTION Antegrade nail in 41 fractures and retrograde femoral intramedullary nails in 30 fractures. MAIN OUTCOME MEASURES Postoperative knee range of motion, Lysholm Knee Score, and isokinetic knee muscle function testing at least 6 months after documented fracture healing, minimum 1 year postoperatively. RESULTS Groups had similar data with regard to demographics and injury patterns. Mean follow-up time was 44 (range: 25-80) months. Mean knee flexion angle was 132 and 134 degrees, and mean Lysholm Score was 84 and 83.1 in antegrade and retrograde groups, respectively (P = 0.893 and P = 0.701). Isokinetic evaluation revealed similar results for peak torque deficiencies at 30 and 180 degrees per second and total work deficiencies at 180 degrees per second (P > 0.05). Age affected the knee functioning as the higher the age of the patient is, the lower the Lysholm Score and knee flexion angle (r = -0.449, P = 0.0321 and r = -0.568, P = 0.001, respectively). CONCLUSIONS Knee function seems to have similar clinical results after either antegrade or retrograde nail insertion for femoral diaphyseal fractures when knee range of motion, Lysholm Scores, and isokinetic knee evaluation are considered as outcome measures. With increasing patient age, a decrease in knee functioning should be anticipated in patients with femoral fractures treated with intramedullary nails regardless of technique.
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12
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How severe are initially undetected injuries to the knee accompanying a femoral shaft fracture? ACTA ACUST UNITED AC 2009; 66:1398-401. [PMID: 19430245 DOI: 10.1097/ta.0b013e31819ea281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fractures of the femur are severe injuries that quickly attract the physician's attention. Previous reports have shown that injuries to the ipsilateral knee can occur. In most cases, such injuries were diagnosed on delay. Excluding cases in which a knee injury was apparent already at admission, we sought to investigate the number and severity of initially undetected lesions to the knee concomitant with a femoral shaft fracture and give an overview of the literature referring to these combined injuries. METHODS Charts and X-rays of patients treated for a femoral shaft fracture from January 2000 until December 2007 were reviewed. Patients, in whom any other injury of the affected limb apart from a midshaft femoral fracture was initially diagnosed, were excluded. Also patients, in whom an injury to the knee had been diagnosed at admission, were excluded. RESULTS Fifty-three patients with 55 midshaft femoral fractures were available for analysis. An injury to the knee was diagnosed in three cases (5%). There was one partial tear of the posterior cruciate ligament and two grade two lesions of the medial meniscus. All lesions were conservatively treated without any after-effects. CONCLUSION Physical examinations under anesthesia, arthroscopy and magnetic resonance imaging have shown lesser correlation among each other than one would expect. More severe injuries to the knee with femoral shaft fractures are more likely to be detected early, than minor ones. Pain about the knee communicated by the awake patient should be the indication for further apparative examination by magnetic resonance imaging or arthroscopy.
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Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. ACTA ACUST UNITED AC 2006; 88:576-80. [PMID: 16645100 DOI: 10.1302/0301-620x.88b5.16875] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- E Katsoulis
- Department of Trauma & Orthopaedics, St James's University Hospital, Beckett Street, Leeds LS9 7TF, UK
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Giannoudis PV, Roberts CS, Parikh AR, Agarwal S, Hadjikouti-Dyer C, Macdonald DA. Knee dislocation with ipsilateral femoral shaft fracture: a report of five cases. J Orthop Trauma 2005; 19:205-10. [PMID: 15758676 DOI: 10.1097/00005131-200503000-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We report the management and outcome of 4 patients with 5 knee dislocations associated with ipsilateral femoral shaft fractures. All patients were managed by immediate reduction of the knee dislocation, intramedullary nailing of the femur, and angiography, followed by postoperative immobilization of the knee (brace or external fixation) for a minimum of 6 weeks. Four of the 5 dislocations underwent a secondary ligament reconstruction. At the 2-year follow up, the mean Knee Society Score was 133 (range 99-170).
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Affiliation(s)
- Peter V Giannoudis
- Department of Trauma and Orthopaedic Surgery, St. James's University Hospital, Leeds, United Kingdom.
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Gaffey A, Blakemore ME. Femoral shaft fractures. TRAUMA-ENGLAND 2003. [DOI: 10.1191/1460408603ta275oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Femoral shaft fractures are not only significant injuries in their own right but also often a marker for multiple, serious injuries elsewhere. The treatment in adults is usually surgical. The results are for the most part good, but are dependent on the degree of injury to the local soft tissues and on the presence or absence of other distant injuries.
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Affiliation(s)
- A Gaffey
- Coventry and Warwickshire Hospital, Coventry, UK
| | - ME Blakemore
- Coventry and Warwickshire Hospital, Coventry, UK,
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Dickson KF, Galland MW, Barrack RL, Neitzschman HR, Harris MB, Myers L, Vrahas MS. Magnetic resonance imaging of the knee after ipsilateral femur fracture. J Orthop Trauma 2002; 16:567-71. [PMID: 12352565 DOI: 10.1097/00005131-200209000-00005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study is to identify and characterize the nature of internal knee derangement associated with ipsilateral femur fractures. DESIGN A prospective consecutive investigation with the musculoskeletal radiologist being blinded to the clinical examination. SETTING A certified Level I trauma center. PATIENTS All adult (skeletally mature) patients with femur fractures resulting from blunt traumatic injury were included. Patients with penetrating, periprosthetic, pathologic, or previous femur fractures were excluded. In addition, all patients with previous knee injuries or previous knee surgery were excluded. Of the fifty-one patients with diaphyseal femur fractures originally enrolled in this investigation, fifteen were excluded by protocol and eleven were unable to obtain timely MRI studies. INTERVENTIONS All patients were evaluated initially according to Advanced Trauma Life Support protocol. When appropriate, skeletal traction was used as provisional fracture stabilization. In most cases, however, operative fixation was performed immediately. In one case open reduction internal fixation was performed. In the remainder, fracture fixation with an anterograde ( = nineteen) or retrograde ( = seven) intramedullary nail was used. OUTCOME MEASURE After surgical fixation, twenty-five patients with twenty-seven knees were examined clinically and with an MRI. RESULTS Five anterior cruciate ligament and two posterior cruciate ligament injuries were discovered (19 percent and 7 percent, respectively). Four complete (Grade 3) medial meniscus tears (15 percent) and seven complete lateral meniscus tears (26 percent) were identified by postoperative MRI studies. The medial collateral ligament was injured in eleven knees (41 percent), with five (19 percent) identified as complete (Grade 3) injuries. The lateral collateral ligament was also injured in eight knees (30 percent); in half (15 percent) the injury was complete. Bone contusions (periarticular infractions of cortical and medullary trabecular bone) were noted in eight (30 percent) tibia (equally divided between medial and lateral compartments) and in 17 (63 percent) femurs (also equally divided between medial and lateral condyles). CONCLUSION Given the large number of soft tissue injuries about the knee, it would be prudent to emphasize the importance of a thorough intraoperative examination once the femur fracture has been stabilized. Additionally, there should be a low threshold to obtain an MRI if the postoperative clinical examination suggests an associated knee injury. Bone bruises, which can only be identified by MRI studies, are increasingly being acknowledged as a source of persistent symptoms.
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Affiliation(s)
- Kyle F Dickson
- Tulane University School of Medicine, New Orleans, Louisiana 70112, USA
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