Elsevier

Injury

Volume 49, Issue 8, August 2018, Pages 1602-1606
Injury

Incidence and risk factors of knee injuries associated with ipsilateral femoral shaft fractures: A multicentre retrospective analysis of 429 femoral shaft injuries

https://doi.org/10.1016/j.injury.2018.06.006Get rights and content

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.

Introduction

A femoral shaft fracture is usually a high-energy injury and, thus, is likely to be accompanied by injuries of adjacent joints. In the literature, knee injuries were associated with 5–55% of femoral shaft fractures [[1], [2], [3], [4]].

Since Pedersen and Serra [5] reported ligamentous injury of ipsilateral knee joint associated with femoral shaft fracture, careful physical examination and awareness of the possibility of associated injury during treatment of femoral shaft fracture was emphasised. However, because of the severe pain and deformity caused by femoral shaft fractures, associated knee injuries were often neglected [6,7]. Associated knee injuries that are not properly diagnosed and treated can cause sequelae such as instability or posttraumatic osteoarthritis, and therefore affects a patient’s quality of life.

The purpose of the current study was to evaluate the incidence and type of knee injury associated with ipsilateral femoral shaft fracture and to identify the risk factors for associated knee injuries.

Section snippets

Materials and methods

From March 2010 to September 2015, the medical records of 516 femoral shaft fractures that were operated on at seven institutions were retrospectively analysed. A femoral shaft fracture was defined as a fracture located between 5 cm distal to the lesser trochanter and the distal femur. The rule of squares was used to define distal femur as the length of the side of the square determined by the widest mediolateral width of the distal femur on an AP radiograph.

Patients who were skeletally

Results

The associated knee injury was found in 30.5% (131/429) of all femoral shaft fractures. There were 87 knee ligament injuries and 69 fractures around the knee joint. In 25 cases, knee ligament injuries and fractures around the knee were combined.

There were no reported intraoperative complications. There were 16 cases (3.7%) of nonunion, 15 cases (3.5%) of delayed union, 3 cases (0.7%) of infection, and 5 cases (1.2%) of instability of the knee joint. Complication rate was significantly higher in

Discussion

In the current study, ipsilateral knee injuries were identified in about 30% of femoral shaft fractures. More than one quarter of ligamentous injuries were not diagnosed before internal fixation. The incidence of knee injury was significantly higher in male patients, type C fracture of AO/OTA classification, and patients injured by traffic accidents. Male sex, AO/OTA type C fractures, and traffic accidents were the risk factors for the associated knee injury in ipsilateral femoral shaft

Conclusion

Knee injuries were identified in about 30% of femoral shaft fractures. More than one-third of single ligament injuries were diagnosed after internal fixation of femoral shaft fractures. Care should be taken since knee injuries can be accompanied by ipsilateral femoral shaft fractures, especially in male, type C fractures of AO/OTA systems and patients injured in traffic accidents.

Conflicts of interest

There is no conflicts of interest to declare.

Acknowledgement

There is nothing to declare about funding source.

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