Title: Evaluation of Concomitant Ligamentous Injuries of Knee Joint in Patients with Ipsilateral Femoral Shaft Fractures

Authors: Dr Rakesh Solanki, Dr Pulak Sharma, Dr Ashish Gohiya

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i7.137

Abstract

It is estimated that the annual incidence of femoral shaft fracture is 9.9 fractures per 100,000 person-years. Concomitant knee injury is a common finding in femoral factures but can be easily missed during early management of initial trauma. Degree of damage to articular structures varies considerably, from only a mild effusion to complete ligament and meniscal tears. In good   number of cases, these injuries are likely to be overlooked or entirely missed. The present study aims at evaluating concomitant ligament injuries of knee joint in patients with ipsilateral femoral shaft fractures by clinical examination under anesthesia after fixation of femoral shaft fractures. Between September 2013 and September 2015, all patients who underwent osteosynthesis for diaphyseal femoral were evaluated by clinical examination under anaestheisa with the aim of assessing the incidence of ligament injuries. There was ACL injury in 18 patients (41%), MCL in 13 (29%), PCL in 7(16%), LCL in 6 (14%).This study showed an overall incidence of ligament injuries in 36.7 % with ipsilateral femoral fractures.

Keywords: Fractures, Femur, Knee, Ligaments.

References

  1. Salminen ST, Pihlajama¨ki HK, Avikainen VJ, Bo¨stman OM(2000) Population based epidemiologic and morphologic study of femoral shaft fractures. Clin Orthop Relat Res 372:241–249
  2. Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults: the influence of ageand gender. J Bone Joint Surg Br 80(2):243–248
  3. Nieves J, Bilezikian J, Lane J, Einhorn T, Wang Y, Steinbuch M,Cosman F (2010) Fragility fractures of the hip and femur incidence and patient characteristics. Osteoporos Int 21(3):399–408
  4. Emami Meybodi, Mohammad Kazem et al. "Concomitant Ligamentous and Meniscal Knee Injuries in Femoral Shaft Fracture." Journal of Orthopaedics and Traumatologyil: Official Journal of the Italian Society of Orthopaedics and Traumatology 15.1 (2014): 35-39. PMC. Web. 8 Nov. 2015
  5. Kumar S, Bahadur R, Kumar V, Duhan S, Aggarwal P. Avulsion fracture of the tibial attachment of the posterior cruciate ligament in association with ipsilateral femoral shaft fracture -report of three cases. Indian J Orthop 2003;37:271-3
  6. Ritchey, S.J.; Schonholtz, G.J.; and Thompson, M.S.: The Dashboard Femoral Fracture Pathomechanics, Treatment and Prevention. J. Bone and Joint Surg., 40A:1347, 1958.
  7. Omer, G.E.; Moll, J. H.; and Bacon, WL: Combined Fractures of the Femur and Tibia in A Single Extremity. Analytic Study of Cases at Brooke General Hospital from 1961-1967. J. Trauma, 8:1026, 1968.
  8. Pedersen HE, Serra JB (1968) Injury to the collateral ligaments of the knee associated with femoral shaft fractures. Clin Orthop Relat Res 60:119-121.
  9. Walker DM, Kennedy JC (1980) Occult knee ligament injuries associated with femoral shaft fractures. Am JSports Med 8(3):172-174
  10. De Coster TA, Teter KE. Knee Ligament Injuries Ipsilateral to Femoral Shaft Fractures. The Iowa Orthopaedic Journal. 1989;9:98-99.
  11. Walling AK, Seradge H, Spiegel PG (1982) Injuries to the knee ligaments with fractures of the femur. J Bone Joint Surg Am 64(9):1324-13
  12. Moore TM, Patzakis MJ, Harvey JP Jr (1988) Ipsilateraldiaphyseal femur fractures and knee ligament injuries. Clin Orthop Relat Res 232:182-18
  13. Szalay MJ, Hosking OR, Annear P (1990) Injury of knee ligament associated with ipsilateral femoral shaft fractures and with ipsilateral femoral and tibial shaft fractures. Injury 21(6):398-400
  14. Vangsness C, Jr, DeCampos J, Merritt P, Wiss D (1993) Meniscal injury associated with femoral shaft fractures. An arthroscopic evaluation of incidence. J Bone Joint Surg Br 75-13(2):207-209.
  15. Buckley, Steven L. M.D.; Sturm, Peter F. M.D.*; Tosi, Laura L. M.D.*; Thomas, Michael D. M.D.*; Robertson, William W. Jr. M.D.*Journal of Pediatric Orthopaedics: March/April 1996 - Volume 16 – Issue 2 - pp 206-209.
  16. Faccini R, Sartori E, Biscione R, Lupi L. Association between fracture of the diaphysis of the femur and lesion of the ligaments of the knee. Chir Organi Mov. 1993;78:177-82
  17. De Campos J, Vangsness CT Jr, Merritt P0, Sher J (1994) Ipsilateral knee injury with femoral fracture. Examination under anesthesia and arthroscopic evaluation. ClinOrthopRelat Res 300:178-182
  18. Blacksin MF, Zurlo JV, Levy AS (1998) Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings. Skeletal Radiol 27 (8):434-439
  19. Dickson KF1, 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 Sep;16(8):567-71.
  20. Taheriazam A, Tahmasebi M. Knee Ligament Injury in Femoral Shaft Fractures. ZJRMS. 2008; 10 (4) :0-0
  21. David W. Sanders, MD, MSc; Mark Mac Leod, MD; Tanya Charyk-Stewart, BSc, MSc; Jeannette Lydestad, RN; Andrea Domonkos, BSc; Christina Tieszer, BSc, MSc Functional outcome and persistent disability after isolated fracture of the femur J can chir, Vol. 51, No 5, octobre 2008
  22. Auffarth A, Bogner R, Koller H ,Tauber M, Mayer M, Resch H, Lederer S (2009) How severe are initially undetected injuries to the knee accompanying a femoral shaft fracture? J Trauma 66(5):1398-1401
  23. CALDAS, Marco Tulio Lopes et al. Injury of the knee ligaments associated with ipsilateral femoral shaft fractures. Rev. bras. ortop. [online]. 2013, vol.48, n.5 [cited 2015-11-08], pp. ------438-440
  24. Kumar, Brajesh et al. "Risks of Concomitant Trauma to the Knee in Lower Limb Long Bone Shaft Fractures: A Retrospective Analysis from a Prospective Study Population." Advanced Biomedical Research 3 (2014):49. PMC. Web. 8 Nov. 2015.
  25. Rodriguez-Merchan EC, Moraleda L, Gomez-Cardero P. Injuries Associated with Femoral Shaft Fractures with Special Emphasis on Occult Injuries. Archives of Bone and Joint Surgery. 2013;1(2):59-63.
  26. Rahim Ebrahimi, Naser Janmohammadi, Mokhtar Esmaeil Nejhad Ganji and Masoud Bahrami Prevalence of Hip and Knee Injuries Combined with Ipsilateral Femoral Shaft Fractures, Shahid Beheshti Hospital, Babol Middle-East Journal of Scientific Research 23 (8): 1862-1867, 2015 ISSN 1990-9233 CD IDOSI Publications, 2015 DOI: 10.5829/idosi.mejsr.2015.23.08.264

Corresponding Author

Dr Rakesh Solanki

Gandhi Medical College and Hamidia Hospital Bhopal (M.P.), India

Contact No. 6264511492, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.