Department of Orthopedics, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Department of Orthopedics, Post Graduate Institute of Medical Education & Research, Chandigarh, 160012, India.
Chin J Traumatol. 2021 Feb;24(1):25-29. doi: 10.1016/j.cjtee.2020.11.010. Epub 2020 Nov 24.
The poor prognosis in patients with floating knee injuries is mainly contributed to articular involvement (Fraser's type Ⅱ). This study aims to evaluate and compare the functional outcomes among different Fraser's type Ⅱ floating knee injuries after surgical management.
Twenty-seven patients with Fraser's type Ⅱ floating knee injuries (54 fractures) between September 2014 and December 2015 were enrolled prospectively in this study and were distributed according to Fraser's floating knee classification into three different groups as type ⅡA (ipsilateral femoral shaft and tibial intra-articular involvement, n = 11), type ⅡB (ipsilateral tibial shaft and femoral intra-articular involvement, n = 9) and type ⅡC (both femoral and tibial intra-articular involvement, n = 7). The differences among the groups were evaluated and compared. The functional outcomes of these injuries at one year were analyzed using Knee Injury and Osteoarthritis Outcome Score (KOOS) which covers 5 subscales of pain, other symptoms, activities of daily living, sports and recreation, and quality of life. The result was also compared with standardized age-sex matched healthy population using paired samples t-test.
All the patients were male, and the injury mechanism was solely roadside accident. The mean age was 29.8 years and injury severity score 17.9 (comparable in all the three groups). Most injuries were observed on the right side (20 cases, 74.1%). Based on paired samples t-test, the KOOS score of patients with Fraser's type ⅡA was found to be better than that of type ⅡB and type ⅡC. Compared with the reference age-sex matched control group, patients with Fraser's type ⅡB and ⅡC fractures had significantly lower mean score in all KOOS subscales (all p < 0.01). However, Fraser's type ⅡA only revealed significant difference regarding the subscales of activities of daily living (p < 0.0001), sports and recreation (p < 0.0001), and quality of life (p < 0.0001).
The results of this study show that patients with Fraser's type ⅡA fractures had a better functional outcome as compared to those with type ⅡB and ⅡC fractures. This might be due to the open intra-articular involvement of the distal femur of the latter two fracture types.
浮膝损伤患者的预后较差，主要与关节受累（弗雷泽Ⅱ型）有关。本研究旨在评估和比较不同弗雷泽Ⅱ型浮膝损伤经手术治疗后的功能结果。
2014 年 9 月至 2015 年 12 月，前瞻性纳入 27 例弗雷泽Ⅱ型浮膝损伤（54 处骨折）患者，根据弗雷泽浮膝分类将患者分为三组：Ⅱ A 型（同侧股骨干和胫骨关节内受累，n=11）、Ⅱ B 型（同侧胫骨骨干和股骨关节内受累，n=9）和Ⅱ C 型（股骨和胫骨关节内均受累，n=7）。评估并比较各组之间的差异。采用膝关节损伤和骨关节炎结果评分（KOOS）分析这些损伤一年后的功能结果，KOOS 包括疼痛、其他症状、日常生活活动、运动和娱乐以及生活质量 5 个亚量表。采用配对样本 t 检验将结果与标准化年龄性别匹配的健康人群进行比较。
所有患者均为男性，损伤机制均为单纯的路边事故。平均年龄为 29.8 岁，损伤严重程度评分 17.9（三组间相似）。大多数损伤发生在右侧（20 例，74.1%）。基于配对样本 t 检验，发现弗雷泽Ⅱ A 型患者的 KOOS 评分优于Ⅱ B 型和Ⅱ C 型。与参考年龄性别匹配的对照组相比，Ⅱ B 型和Ⅱ C 型骨折患者的所有 KOOS 亚量表的平均得分均显著较低（均 p<0.01）。然而，Ⅱ A 型仅在日常生活活动（p<0.0001）、运动和娱乐（p<0.0001）以及生活质量（p<0.0001）亚量表方面有显著差异。
本研究结果表明，与Ⅱ B 型和Ⅱ C 型骨折患者相比，Ⅱ A 型骨折患者的功能结果更好。这可能是由于后两种骨折类型的股骨远端存在开放性关节内受累。
