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Journal of Orthopaedics and Traumatology

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Open Access 01-03-2014 | Original Article

Concomitant ligamentous and meniscal knee injuries in femoral shaft fracture

Authors: Mohammad Kazem Emami Meybodi, Morteza Jannesari Ladani, Tohid Emami Meybodi, Alireza Rahimnia, Ahmad Dorostegan, Jalil Abrisham, Habib Yarbeygi

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2014

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.

Salminen ST, Pihlajamäki HK, Avikainen VJ, Böstman OM (2000) Population based epidemiologic and morphologic study of femoral shaft fractures. Clin Orthop Relat Res 372:241–249PubMedCrossRef

van Staa TP, Dennison EM, Leufkens HGM, Cooper C (2001) Epidemiology of fractures in England and Wales. Bone 29(6):517–522PubMedCrossRef

Singer BR, McLauchlan GJ, Robinson CM, Christie J (1998) Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 80(2):243–248PubMedCrossRef

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):399–408PubMedCrossRef

Bengnér U, Ekbom T, Johnell O, Nilsson BE (1990) Incidence of femoral and tibial shaft fractures: epidemiology 1950–1983 in Malmö, Sweden. Acta Orthopaedica 61(3):251–254CrossRef

Arneson TJ, Melton LJI, Lewallen DG, O’Fallon WM (1988) Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965–1984. Clin Orthop Relat Res 234:188–194PubMed

Hedlund R, Lindgren U (1986) Epidemiology of diaphyseal femoral fracture. Acta Orthopaedica 57(5):423–427CrossRef

Wong PCN (1966) Fracture epidemiology in a mixed southeastern Asian community (Singapore). Clin Orthop Relat Res 45:55–62PubMedCrossRef

Moore TM, Patzakis MJ, Harvey JP Jr (1988) Ipsilateral diaphyseal femur fractures and knee ligament injuries. Clin Orthop Relat Res 232:182–189PubMed

10.

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):1398–1401PubMedCrossRef

11.

Rowntree M, Getty CJM (1981) The knee after midshaft femoral fracture treatment: a comparison of three methods. Injury 13(2):125–130PubMedCrossRef

12.

Ritchey SJ, Schonholtz GJ, Thompson MS (1958) The dashboard femoral fracture; pathomechanics, treatment, and prevention. J Bone Joint Surg Am 40-A(6):1347–1358

13.

Walker DM, Kennedy JC (1980) Occult knee ligament injuries associated with femoral shaft fractures. Am J Sports Med 8(3):172–174PubMedCrossRef

14.

Pedersen HE, Serra JB (1968) Injury to the collateral ligaments of the knee associated with femoral shaft fractures. Clin Orthop Relat Res 60:119–121PubMedCrossRef

15.

Walling AK, Seradge H, Spiegel PG (1982) Injuries to the knee ligaments with fractures of the femur. J Bone Joint Surg Am 64(9):1324–1327PubMed

16.

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):398–400PubMedCrossRef

17.

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-B(2):207–209

18.

De Campos J, Vangsness CT Jr, Merritt PO, Sher J (1994) Ipsilateral knee injury with femoral fracture. Examination under anesthesia and arthroscopic evaluation. Clin Orthop Relat Res 300:178–182PubMed

19.

Evans RC (2008) Illustrated orthopedic physical assessment. Mosby, New York, p 1208

20.

Blacksin MF, Zurlo JV, Levy AS (1998) Internal derangement of the knee after ipsilateral femoral shaft fracture: MR imaging findings. Skeletal Radiol 27(8):434–439PubMedCrossRef

21.

Donaldson WF, Warren RF, Wickiewicz T (1985) A comparison of acute anterior cruciate ligament examinations: initial versus examination under anesthesia. Am J Sports Med 13(1):5–10PubMedCrossRef

22.

Umans H, Wimpfheimer O, Haramati N, Applbaum YH, Adler M, Bosco J (1995) Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. AJR Am J Roentgenol 165(4):893–897PubMedCrossRef

23.

Mehrdad R (2009) Health system in Iran. JMAJ 52(1):69–73

24.

Zargar M, Khaji A, Karbakhsh M (2006) Pattern of motorcycle-related injuries in Tehran, 1999 to 2000: a study in 6 hospitals. East Mediterr Health J 12(1–2):81–87PubMed

25.

Winquist RA, Hansen ST Jr (1980) Comminuted fractures of the femoral shaft treated by intramedullary nailing. Orthop Clin North Am 11(3):633–648PubMed

Title: Concomitant ligamentous and meniscal knee injuries in femoral shaft fracture
Authors: Mohammad Kazem Emami Meybodi
Morteza Jannesari Ladani
Tohid Emami Meybodi
Alireza Rahimnia
Ahmad Dorostegan
Jalil Abrisham
Habib Yarbeygi
Publication date: 01-03-2014
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2014
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-013-0255-x

At a glance: The STEP trials

Springer Medicine

Concomitant ligamentous and meniscal knee injuries in femoral shaft fracture

Abstract

Background

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

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