ABSTRACT
Twenty-one patients with fractures of the ipsilateral femur and tibia were treated at Boston City Hospital from 1982 through 1987. Fourteen (67%) of the 21 patients sustained a total of 17 open fractures (76% of which were grade II or III wounds). Over 50% of the patients suffered concomitant ipsilateral knee injuries. Associated injuries required 37 nonorthopaedic procedures; 30 orthopaedic procedures were required to stabilize the axial skeleton and the other three extremities. Five patients ultimately required amputation, reflecting the magnitude of the initial high-energy trauma. Superior results were achieved when early rigid intramedullary fixation of the femur and rigid stabilization of the tibia with either an intramedullary nail or an external fixator was undertaken. Patients that underwent initial rigid intramedullary fixation of both the femur and tibia required fewer secondary operative procedures than those treated with primary external fixation. Rigid internal fixation allowed for thorough evaluation and treatment of the ligamentous structures of the knee and facilitated management of the soft tissue trauma.
Subject(s)
Femoral Fractures/complications , Knee Injuries/complications , Ligaments, Articular/injuries , Tibial Fractures/complications , Adolescent , Adult , Aged , Amputation, Surgical , Child , Female , Femoral Fractures/therapy , Fracture Fixation, Intramedullary , Humans , Knee Injuries/physiopathology , Knee Injuries/therapy , Knee Joint/physiopathology , Male , Middle Aged , Orthopedic Fixation Devices , Range of Motion, Articular , Retrospective Studies , Tibial Fractures/therapyABSTRACT
Of four patients who were treated between May 1985 and November 1987 and who had both a lateral malleolar fracture and a tear of the lateral ligaments of the ipsilateral ankle, three could be followed. The fractured malleolus was treated with rigid internal fixation, but the injury to the lateral ligaments was not diagnosed until the ankle was stressed to test for stability after the internal fixation. We believe that if disruption of the lateral ligaments is noted at operation, repair is indicated. This involves only a slight prolongation of time under anesthesia and markedly increases the chances for a stable ankle. It is important to check intraoperatively for a possible tear of the lateral ligaments in a patient who has a fracture of the ankle, especially when the injury was caused by high-energy trauma.
