Analysis Of Risk Factors For Distal Femoral Fracture With Knee Joint Meniscus And Ligament Injuries

Objective To determine the incidence of distal femoral fracture combined with ipsilateral knee meniscus and ligament injuries,and to explore the risk factors of distal femoral fracture combined with meniscus and ligament injuries.To provide clinical basis for the treatment of distal femoral fracture.Methods A retrospective analysis was performed on the clinical data of 118 patients with unilateral distal femur fracture who were hospitalized in the trauma department of orthopedics in Tianjin Hospital from January 2018 to December 2019。All patients performed X-ray and CT and MRI examination to determine the fracture and the knee meniscus and ligament injuries.Basic data such as gender,age,affected side(left/right),cause of injury were counted.Fracture related data were recorded such as the type of fracture,the distance of the fracture line from the plane to the femoral condyle,whether combined with other fractures,whether the knee was swollen and tender at the time of admission.According to different ages,genders,cause of injuries and fracture types,the incidence rates of MM,LM,ACL,PCL,MCL and LCL injuries in each group were summarized.The chi-square test were used to compare the difference in injuries incidence between the groups,and the risk factors related to the knee meniscus and ligaments injuries were determined.Binomial logistic regression analysis was used to identify the independent risk factors.P<0.05 was considered statistically significant.Results Among the 118 cases of distal femoral fractures,47 were males and 71 were females,aged of 20-80 years,with an average of 54.5.According to the AO/OTA classification,there were 75 cases of type A,19 cases of type B and 24 cases of type C.The incidence of single structural injuries is as follows,37 cases(31.36%)combined MM injuries,46 cases(38.98%)with LM injuries,44 cases of ACL injuries(38.98%),30 cases(25.42%)of PCL injuries,MCL injuries in 47patients(39.83%),25 cases(21.19%)had LCL injuries.A total of 64 patients(54.24%)with meniscus injuries,54(45.76%)had cruciate ligament injuries,and 59(50.00%)had collateral ligament injuries.Single factor analysis suggested that gender,cause of injury and fracture type were the factors related to meniscus injuries of kneejoint(P<0.05).The results of multivariate analysis suggested that gender and fracture type were independent risk factors for knee joint meniscus injuries.The risk of meniscus injuries was significantly increased in males(P=0.030),type of A3(P<0.001)and C(P<0.001)fractures.The risk factors for knee ligament injuries included the cause of injuries,fracture type,knee joint swelling and tenderness,and the distance from the fracture line to the femoral condyle(P<0.05).The results of multivariate analysis suggested that cause of injuries and knee swelling were independent risk factors for cruciate ligament injuries.The risk of patients with motor vehicle accident(P=0.005)and knee swelling(P=0.007)were significantly increased.The cause of injury and fracture type are independent risk factors for collateral ligaments injuries,among which motor vehicle accident(P=0.044)and c-type fracture(P=0.036)significantly increase the risk of patients with cruciate ligament.Conclusions The incidence of ipsilateral knee joint meniscus and ligaments injuries was higher in distal femur fractures.The incidence of lateral meniscus injuries was higher than the incidence of medial meniscus injuries.Among ligaments injuries,the incidence of MCL was the highest,followed by ACL,and the injuries rate of PCL and LCL was slightly lower. Gender,cause of injuries and fracture type were the risk factors of knee meniscus injuries.The independent risk factors for meniscus injuries included gender,fracture type.The risk of meniscus injuries was significantly increased in males,fracture type of A3 and C.The risk factors for knee ligaments injuries include fracture type,cause of injuries,swelling of the knee,tenderness,and the distance from the fracture line to femoral condyle.The independent risk factors for cruciate ligament injuries include cause of injuries and knee swelling,and the independent risk factors for collateral ligaments injuries include the cause of injuries and fracture type.The risk of collateral ligaments injuries in patients with motor vehicle accident and c-type fracture is significantly increased.Further MRI examination is necessary to clarify the knee joint injuries in patients with this kind of disease.