Orthopedic Surgery Department, Baghiatallah University of Medical Sciences, Tehran, Iran.
J Orthop Traumatol. 2014 Mar;15(1):35-9. doi: 10.1007/s10195-013-0255-x. Epub 2013 Jul 24.
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.
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.
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.
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.
膝关节损伤是股骨骨折的常见并发症，但在初次创伤的早期处理中很容易被忽视。关节结构的损伤程度差异很大；从轻微的积液到完全的韧带和半月板撕裂。由于之前的报告大多来自发达国家，因此本研究旨在观察伊朗样本中伴随的膝关节损伤特征，以代表发展中国家的观点。
2008 年 10 月至 2009 年 9 月，连续收治的股骨骨折患者被纳入这项研究，这些患者被收入巴齐亚塔勒哈医院（德黑兰，伊朗）的骨科病房。在符合研究纳入标准的患者中，对膝关节进行关节镜或开放手术检查、ADT、lachman 试验、麻醉下的内外翻应力试验，以确定膝关节损伤的发生率。
40 例同侧和 2 例双侧股骨骨折患者接受了研究。关节镜检查发现 12 例（27%）膝关节内侧半月板损伤。3 例（7%）外侧半月板损伤，18 例（40.9%）前交叉韧带损伤和 2 例（4.5%）后交叉韧带损伤。内外翻应力试验中，15 例（34%）内侧副韧带和 4 例（9%）外侧副韧带松弛。lachman 试验阳性 3 例（6%），ADT 阳性 2 例（4.5%）。
根据我们的观察，股骨骨干骨折常伴有韧带和半月板膝关节损伤，这些损伤的发生率与发达国家的报告基本一致。
