Ebrahimzadeh Mohammad Hosein, Birjandinejad Ali, Moradi Ali, Fathi Choghadeh Maysam, Rezazadeh Jafar, Omidi-Kashani Farzad
Orthopaedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran.
Mass General Hospital, Harvard Medical School, Boston, USA.
Trauma Mon. 2015 Feb;20(1):e21635. doi: 10.5812/traumamon.21635. Epub 2015 Feb 2.
Fractures of the knee account for about 6% of all trauma admissions. While its management is mostly focused on fracture treatment, it is not the only factor that defines the final outcome.
This study aimed to study objective and subjective outcomes after proximal tibial versus distal femoral fractures in terms of knee instability and health-related quality of life.
This retrospective, cross-sectional, cohort study was carried out on 80 patients with either isolated proximal tibial (n = 42) or distal femoral (n = 38) fractures, who underwent open reduction and internal fixation. All the fractures were classified based on the Schatzker and AO classification for tibial plateau and distal femoral fractures, respectively. The patients were followed and examined by an orthopedic knee surgeon for clinical assessment of knee instability. In their last follow-up visit, these patients completed a Lysholm knee score and the short-form (SF) 36 health survey.
Among the 42 tibial plateau fractures, 25% were classified as Schatzker type 2. Of the 38 distal femoral fractures, we did not find any type B1 or B3 fractures. The overall prevalence of anterior and posterior instability was 42% and 20%, respectively. Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL) injuries were detected clinically in 50% and 28%, respectively. The incidence rates of ligament injuries in tibial plateau fractures were as follows: Anterior Collateral Ligament (ACL) 26%, Posterior Collateral Ligament (PCL) 7%, MCL 24%, and LCL 14%. Medial collateral ligament injury was the most common in the Schatzker type 2 (50% of the injuries). Distal femoral fractures were associated with ACL injury in 16%, PCL in 13%, MCL in 26% and LCL in 14%. However, final knee range of motion (ROM) and function (Lysholm score) were not associated with fracture location. No statistically significant difference was observed between the two groups, except for the valgus stress test at 30°knee flexion, which was more positive in tibial fractures. All eight domains of SF-36 score in the distal femoral and proximal tibial fractures were significantly different from the normal values; however, there were no statistically significant differences between femoral and tibial fracture scores.
Although ROM is acceptable in knee joint fractures, instability is common. However, it seems that knee function and quality of life are not associated with the location of the fracture.
膝关节骨折约占所有创伤入院病例的6%。虽然其治疗主要集中在骨折处理上，但这并非决定最终结果的唯一因素。
本研究旨在从膝关节不稳定和健康相关生活质量方面，比较胫骨近端骨折与股骨远端骨折后的客观和主观结果。
本回顾性、横断面队列研究对80例分别为单纯胫骨近端骨折（n = 42）或股骨远端骨折（n = 38）的患者进行，这些患者均接受了切开复位内固定术。所有骨折分别根据Schatzker分类法和AO分类法对胫骨平台骨折和股骨远端骨折进行分类。由一名骨科膝关节外科医生对患者进行随访和检查，以临床评估膝关节不稳定情况。在最后一次随访时，这些患者完成了Lysholm膝关节评分和简短形式（SF）36健康调查问卷。
在42例胫骨平台骨折中，25%被分类为Schatzker 2型。在38例股骨远端骨折中，未发现任何B1型或B3型骨折。前后不稳定的总体发生率分别为42%和20%。临床检测到内侧副韧带（MCL）和外侧副韧带（LCL）损伤的发生率分别为50%和28%。胫骨平台骨折中韧带损伤的发生率如下：前交叉韧带（ACL）26%，后交叉韧带（PCL）7%，MCL 24%，LCL 14%。内侧副韧带损伤在Schatzker 2型骨折中最为常见（占损伤的50%）。股骨远端骨折中ACL损伤的发生率为16%，PCL为13%，MCL为26%，LCL为14%。然而，最终膝关节活动范围（ROM）和功能（Lysholm评分）与骨折部位无关。除了膝关节屈曲30°时的外翻应力试验在胫骨骨折中更阳性外，两组之间未观察到统计学上的显著差异。股骨远端骨折和胫骨近端骨折的SF - 36评分的所有八个领域均与正常值有显著差异；然而，股骨骨折和胫骨骨折评分之间没有统计学上的显著差异。
虽然膝关节骨折后的ROM可接受，但不稳定情况很常见。然而，膝关节功能和生活质量似乎与骨折部位无关。
