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Knee Injury Associated With Acetabular Fractures: A Multicenter Study of 1273 Patients
Harish Kempegowda1, Hemil H Maniar, Akhil A Tawari
1*Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA;†Orthopaedic Associates of Michigan, Grand Rapids, MI;‡Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA; and§Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA.
Objectives:
The purpose of this study was to determine the incidence and pattern of the knee injury associated with acetabular fractures.
Design:
Retrospective cohort study.
Setting:
Three level I and one level II trauma centers.
Patients:
A total of 1273 skeletally mature patients treated at 4 trauma centers between November 2004 and December 2013 for acetabular fractures were retrospectively identified from orthopaedic trauma databases.
Intervention:
Analysis of all acetabular fractures with knee injury regarding type of acetabular fracture, mechanism of injury, energy of injury, pattern of the knee injury, knee examination findings at initial presentation, intraoperative and on follow-up, requirement for surgery/conservative management, and the associated injuries. The clinical data entered during inpatient stay and office visits were analyzed.
Main Outcome Measures:
Incidence and pattern of the knee injury.
Results:
One hundred ninety-three of 1273 patients (15%) were found to have ipsilateral knee symptoms within a period of 1 year from the date of injury. The patterns of knee injury included 56 fractures (29%), 49 ligamentous lesions (25%), and 88 miscellaneous (46%) causes including bone bruises, wounds, and swelling. Associated injuries included 85 patients with ipsilateral hip dislocation (45%), 59 pelvic injuries (31%), 61 extremity injuries (32%), 38 head injuries (20%), 37 chest injuries (20%), 23 abdominal and genitourinary injuries (12%), and 7 injuries of the spine (4%).
Conclusion:
Based on this study, we conclude that knee injuries associated with high-energy acetabular fractures constitute a significant portion of the patient population. Ligament injuries are frequently overlooked and thorough clinical evaluation and utilization of magnetic resonance imaging in selected cases will help in early detection and prevention of long-term complications.
Level Of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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