Characteristics and risk factor analysis of femoral supracondylar fractures combined with meniscal and?ligamentous knee?injuries / 中华创伤杂志

ABSTRACT

Objective:To analyze the characteristics and related risk factors of femoral supracondylar fractures combined with meniscus and ligament injuries.Methods:A retrospective case series analysis was performed on clinical data of 100 patients with femoral supracondylar fractures combined with ipsilateral meniscal and?ligamentous knee?injuries?admitted to Tianjin Hospital from January 2016 to December 2020. There were 55 males and 45 females，with age of 22-78 years［（38.5 ± 3.3）years］. Causes of injury included traffic accidents in 45 patients，falls in 45 and others in 10. According to AO classification，type A1 was in 56 patients，A2 in 33 and A3 in 11. Sixty of these patients presented fractures on the left side and forty on the right side. All patients accepted MRI examination to estimate meniscal and ligamentous knee injuries concerning its prevalence，locations and severity. Locations of injury included the medial meniscus（MM），lateral meniscus（LM），anterior cruciate ligament（ACL），posterior cruciate ligament（PCL），medial collateral ligament（MCL）and lateral collateral ligament（LCL）. Meniscal knee injuries were measured using Stoller four-level method，and ligamentous knee injuries by Ruiz three-level method. The patients were subdivided based on age，sex，causes of injury，injury side and fracture AO classification to measure the prevalence of meniscal and?ligamentous injuries，and to identify the factors related to injuries using logistic regression analysis.Results:Seventy-six patients（76.0%）were complicated with meniscal or ligamentous injuries in 151 different parts. Twenty-nine patients（29.0%）had both meniscal and ligamentous injuries. Fifty-six patients had meniscal injuries，including 11 with bilateral meniscus injuries. MM injuries were noted in 32 patients（32.0%），with severity of grade Ⅰ in 19 patients，grade Ⅱ in 12 and grade Ⅲ in 1. LM injuries were found in 35 patients（35.0%），with severity of grade Ⅰ in 19 patients，grade Ⅱ in 14 and grade Ⅲ in 2. Forty-nine patients had ligamentous injuries，among which 22 patients were with single ligamentous injuries，19 with double ligamentous injuries and 8 with triple ligamentous injuries. ACL injuries were found in 33 patients（33.0%），with severity of grade Ⅰ in 22 patients，grade Ⅱ in 10 and grade Ⅲ in 1. PCL injuries occurred in 4 patients（4.0%），with severity of grade Ⅰ in 3 patients and grade Ⅱ in 1. MCL injuries occurred in 28 patients（28.0%），with severity of grade Ⅰ in 18 patients，grade Ⅱ in 9 and grade Ⅲ in 1. LCL injuries occurred in 19 patients，with severity of grade Ⅰ in 12 patients，grade Ⅱ in 5 and grade Ⅲ in 2. There were significant differences in prevalence of meniscal injuries among subgroups of different gender，causes of injury and fracture types（ P < 0.05）.Logistic regression analysis suggested that gender and fracture types showed significant correlation with meniscal injuries，especially factors of males（ P < 0.05）and type A3 fractures（ P < 0.01）. There were significant differences in prevalence of ligamentous injuries among subgroups of different causes of injury and fracture types（ P < 0.05）. Logistic regression analysis showed that causes of injury and fracture types were significantly related to ligamentous injuries，especially factors of traffic accidents（ P < 0.01）and type A3 fractures（ P < 0.01）. Conclusions:Ipsilateral meniscal or ligamentous knee injuries have a high incidence in patients with supracondylar femoral fractures. There exist multiple-site injuries，particularly in ligamentous injuries. Males，type A3 fractures and traffic injuries are risk factors，which needs to be paid much attention in clinical diagnosis and treatment.