Dawood Muhammad Hamza, Shahzad Muhammad Gulfam, Perveen Haseefa, Daniyal Muhammad, Sohail Sheza, Roshan Mavra
United Medical and Dental College, Affiliated with Jinnah Sindh Medical University, Karachi, Pakistan.
Trauma Orthopedic Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan.
SAGE Open Med. 2024 Jan 22;12:20503121231222822. doi: 10.1177/20503121231222822. eCollection 2024.
This study aims to elaborate the incidence, types, and characteristics of ligamentous knee injuries accompanying femoral-shaft fractures and their association with demographic data, fracture characteristics, and injury mechanism.
This multi-center-prospective-observational study examined patients in the Shaheed Mohtarma Benazir Bhutto Institute of Trauma and Civil Hospital orthopedic wards. Using the consecutive sampling technique, 146 patients with femoral-shaft fractures were recruited, and scrutinized to determine the presence of ligamentous knee injury, through an evaluation form encompassing patients' demographic data, fracture characteristics, knee examinations, and confirmed through magnetic resonance imaging. Knee injuries were detected intra-operatively under regional/general anesthesia and post-operatively utilizing diagnostic maneuvers (varus/valgus stress, Lachman, anterior/posterior drawer, external rotation recurvatum, and McMurray tests) by 2-3 surgeons and confirmed through magnetic resonance imaging. Magnetic resonance imaging was exclusively employed in suspected false positive/negative cases, and when a titanium implant was utilized, that is, 131 cases (89.7%). Chi-square test was used to assess the relationship between incidence and type of ligamentous knee injury with demographic data, injury mechanism, and fracture characteristics.
Among the 146 patients with femoral-shaft fractures, 78% and 22% were males and females, with 37% experiencing associated ligamentous knee injury. Medial collateral ligament and anterior cruciate ligament were the commonest types of ligamentous injuries accompanying femoral-shaft fractures, at 44% and 33%. The Chi-square revealed a statistically significant association between the incidence of ligamentous knee injury accompanying femoral-shaft fracture with demographic data, injury mechanism, and fracture characteristics (-value < 0.05), and was noted to be higher among males (55.6%), participants aged 18-25 years (66.7%), involved in a road traffic accident (88.9%), resulting in a complex (77.8%) and close fracture (88.9%). A similar association was seen between medial collateral ligament and anterior cruciate ligament injuries with age, injury mechanism, and fracture characteristics (-value < 0.05).
Our study revealed the unaddressed fact that Pakistan has a significant incidence of ligamentous knee injuries accompanying femoral-shaft fractures. These insights can empower clinicians/surgeons to understand and manage this condition effectively.
本研究旨在阐述股骨干骨折伴发的膝关节韧带损伤的发生率、类型和特点，以及它们与人口统计学数据、骨折特征和损伤机制之间的关联。
这项多中心前瞻性观察研究对沙希德·莫赫塔尔玛·贝娜齐尔·布托创伤研究所和市民医院骨科病房的患者进行了检查。采用连续抽样技术，招募了146例股骨干骨折患者，并通过一份涵盖患者人口统计学数据、骨折特征、膝关节检查的评估表进行仔细检查，以确定是否存在膝关节韧带损伤，并通过磁共振成像进行确认。膝关节损伤在区域/全身麻醉下术中检测，并在术后由2至3名外科医生利用诊断手法（内翻/外翻应力、拉赫曼试验、前后抽屉试验、外旋反屈试验和麦克马瑞试验）进行检测，并通过磁共振成像进行确认。磁共振成像仅用于疑似假阳性/阴性病例以及使用钛植入物的情况，即131例（89.7%）。采用卡方检验评估膝关节韧带损伤的发生率和类型与人口统计学数据、损伤机制和骨折特征之间的关系。
在146例股骨干骨折患者中，男性和女性分别占78%和22%，37%的患者伴有膝关节韧带损伤。内侧副韧带和前交叉韧带是股骨干骨折伴发的最常见韧带损伤类型，分别占44%和33%。卡方检验显示，股骨干骨折伴发的膝关节韧带损伤的发生率与人口统计学数据、损伤机制和骨折特征之间存在统计学上的显著关联（P值<0.05），并且在男性（55.6%）、18至25岁的参与者（66.7%）、涉及道路交通事故的患者（88.9%）、导致复杂骨折（77.8%）和闭合性骨折的患者（88.9%）中发生率更高。内侧副韧带和前交叉韧带损伤与年龄、损伤机制和骨折特征之间也存在类似的关联（P值<0.05）。
我们的研究揭示了一个未被关注的事实，即巴基斯坦股骨干骨折伴发膝关节韧带损伤的发生率很高。这些见解可以使临床医生/外科医生有效地了解和处理这种情况。
