COMPLEX TRAUMA OF THE KNEE-JOINT - DIAGNO SIS - MANAGEMENT - PRINCIPLES OF THERAPY

The complex nature of combined fractures and soft tissue injuries of t he distal femur and proximal tibia needs special attention and specifi c management. Distal femoral and proximal tibial fractures in young pa tients are usually caused by high-energy trauma. They are complicated by a high rate of systemic and local injuries to cartilage, ligaments and skin. This small but important group with severe injuries needs a detailed treatment algorithm, because despite the treating surgeon's s kill, enthusiasm and wishful thinking, these injuries frequently lead to unsatisfactory results. The combination of distal femoral fractures and proximal tibial fractures was defined as complex knee injury type 1; the combination of distal femoral fractures or proximal tibial fra ctures with second or third degree open or closed soft-tissue injury w as defined as complex knee injury type 2; knee dislocations were defin ed as complex knee injury type 3. A decision-making scheme is presente d specifically addressing timing and treatment modalities. Out of 116 type 1 and 2 complex knee injuries, 8 had a deep infection, in 6 cases an amputation was carried out and in 4 cases a knee arthrodesis was p er formed. In 81 isolated distal femoral fractures, only 4 had a deep infection, none needed amputation, and ic only 1 case did a knee arthr odesis have to be performed. The average Neer Score in 90 followed-up complex knee injuries, types 1 and 21 was 76.5+/-13.5 compared with 82 .8+/-10 (out of 54 isolated distal femoral fractures). Out of 37 cases with knee dislocation, 22 (60%) had an poor result according to the L ysholm Score (average Lysholm Score 60.7+/-28).