The Clinical Study Of The Femoral Shaft Fracture Associated With Knee Injury

Objective: To investigate the incidence of the femoral shaft fracture associated with knee injury, to assess the value of intraoperative knee physical examination during anesthesia by give knee MRI and intraoperative knee physical examination during anesthesia through Femoral fractures patients after admission. Cause broad orthopaedic surgeon's attention, reduce omission diagnostic rate of femoral shaft fracture associated with injury of knee.Methods: This investigation was conducted with the thirty patients(M 20. F 10; average age 40) presenting to the Third Hospital Affiliated to Hebei Medical University trauma center. All patients sustaining diaphyseal femur fractures were eligible for participation during the time period June 2009 to March in 2011. 24 cases for car accident injury, 5 cases for falling injury, and 1 case of clog pounding injury. 30 patients after admission were asked for details of the history and given the physical examination, relevant inspection including travelling spine, pelvis, chest X-ray was perfected according to patients with different clinical symptoms and signs. Femoral X-ray should include positive side position and adjacent hip and knee. Patients with penetrating, periprosthetic, pathologic, or previous femur fractures were excluded. In addition, all patients with previous knee injuries or previous knee surgery were excluded. patients were excluded for reasons including refusal to undergo MRI and previous surgery with metallic implants. The patients associatied with distal femur fracture and proximal tibia fracture were excluded. The 23 patients meeting the conditions (type A1, 4,A2, 3,A3, 1,B1, 7, B2, 4,B3,2,C2,2, C3,2) were underwent lateral knee with MRI. The categorical statistics and record were doing by using MRI images high signal clear whether merger knee injuries and severity, according to whether combination cruciate ligament, inside and outside ligamentous injury and meniscal injury. Temporary tibial nodules bone traction was done to stable fracture and alleviate clinical symptoms after all inspection were done. The surgery were done on 3～5 days after the illness was smooth. In all cases, locked anterograde (twenty patients) or retrograde (five patients) intra -medullary nails were used. the internal fixation materials are titanium alloy.At the time of the operative procedure, a comprehensive knee examination including drawer test and Lachman test and lateral stress test was performed and recorded to assess the integrity of the major ligamentous structures after fixation of the fracture. The knee MRI diagnosis of knee joint injuries were used as the gold standard. The statistics processing was done by comparing the intraoperative knee physical examination results during anesthesia with the gold standard. To predict the incidence of femoral shaft fractures associated with injury of knee and evaluate the value of intraoperative knee physical examination during anesthesia by Calculating the sensitivity, specificity, mistake diagnostic rate, omission diagnostic rate.Results: 23 patients were studied in this paper, a total of 25 cases with bilateral femoral fractures were to do MRI,20 cases of which combined knee injury, the positive rate is 80%.Six anterior cruciate ligament (ACL) and two posterior cruciate ligament (PCL) (24 percent and 8 percent, respectively) injuries were reported by MRI. In both patients with PCL injuries, ACL injuries were also noted. Eleven medial collateral ligament(MCL) injuries (44 percent) were noted on the MRI examinations. Of these, five(20percent) were reported as complete tears. Three lateral collateral ligament (LCL) injuries (12 percent) were noted on the MRI examinations. Of these, two (8 percent) were reported as complete tears. The medial meniscus was injured in four and the lateral meniscus was injured in six of the knees studied. MRI revealed ten bone contusions (40 percent). Five ACL injuries (20 percent) and both PCL injuries (8 percent) and eleven MCL injuries(44 percent) and three LCL (12 percent) injuries were detected during the intraoperative physical examination.Four of the six ACL injuries and both PCL injuries were detected during the intraoperative physical examination. Conversely, in one case an ACL injury was reported by intraoperative physical examination that was not confirmed by MRI findings. Four of the eleven MCL injuries and one of the three LCL injuries were not detected during the intraoperative physical examination. Conversely, four MCL injures and one LCL injures were reported by intraoperative physical examination that were not confirmed by MRI findings. The sensitivity and specificity and mistake diagnostic rate and omission diagnostic rate of physical examination in the detection of ACL injury were 66.7 percent and 94.7 percent and 5.3 percent and 33.3 percent, respectively. Physical examination was 100 percent specific and sensitive in the detection of PCL injury. The sensitivity and specificity and mistake diagnostic rate and omission diagnostic rate of physical examination in the detection of MCL injury were 63.6 percent and 71.4 percent and 28.6 percent and 36.4 percent. Physical examination had a sensitivity of 66.7 percent and specificity of 95.5 percent and mistake diagnostic rate 4.5 percent and omission diagnostic rate 33.3 percent in the detection of injury to the LCL.Conclusion: Femoral shaft fractures associated with knee injuries have a high incidence, Most of the femoral fractures merger bone bruise which is also the reasons of the knee persistent pain. intraoperative knee physical examination during anesthesia which can not find meniscus injury and bone contusions has the certain mistake diagnostic rate and omission diagnostic rate. Knee MRI as a noninvasive test method has a high sensitivity and specificity. Knee MRI that can rapid diagnosis knee injuries is helpful for early treatment.