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. 2025 Aug 12;13(3):124.
doi: 10.3390/medsci13030124.

Over 10% of Surgically Treated High-Energy Pelvic Fractures Are Associated with Undiagnosed Ligamentous Knee Injuries: An Epidemiologic Study in Italy's Largest Trauma Center

Simone Giusti  1 , Vittorio Alfonsi  1 , Edoardo De Fenu  1 , Claudia Franco  1 , Stefano Cacciatore  2 , Francesco Liuzza  3 , Ezio Adriani  1
Affiliations

Over 10% of Surgically Treated High-Energy Pelvic Fractures Are Associated with Undiagnosed Ligamentous Knee Injuries: An Epidemiologic Study in Italy's Largest Trauma Center

Simone Giusti et al. Med Sci (Basel). .

Abstract

Purpose: To evaluate the prevalence of undiagnosed ligamentous knee injuries in patients surgically treated for high-energy pelvic ring or acetabular fractures and propose a mechanism to diagnose these briefly post-hospital discharge.

Methods: A retrospective case series (level of evidence IV) was conducted at Italy's largest trauma center. Medical records from 2018 to 2023 were reviewed to identify patients who underwent surgical treatment for pelvic or acetabular fractures. Eligible patients were contacted for a structured telephone interview, which included a questionnaire on knee symptoms and the International Knee Documentation Committee (IKDC) score. Associations between demographic factors, trauma mechanism, and knee outcomes were statistically analyzed.

Results: Fifty-nine patients (mean age 55 years, 72.9% male) were enrolled. Undiagnosed knee ligament injuries were present in 11.9%, with an additional 8.5% reporting persistent knee symptoms. The average time to diagnosis was 6.4 months post-discharge. Patients involved in road traffic accidents showed a significantly higher incidence of knee injuries (34.8%) compared to those who fell from a height (3.9%) (p = 0.049). Patients who had undergone ligament reconstruction had significantly lower IKDC scores (62.0 ± 8.2) than non-surgical cases (82.4 ± 12.1, p = 0.0002). No association was found with age or sex.

Conclusions: Ligamentous knee injuries are frequently overlooked in the acute management of high-energy pelvic fractures, particularly in road traffic accidents. A systematic knee assessment before discharge or early outpatient imaging should be considered to improve detection and outcomes.

Keywords: ACL; PCL; multi-ligament injury; pelvic fractures; undiagnosed.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Participant selection flowchart.
Figure 2
Figure 2
Age and sex distribution of the study population.
See this image and copyright information in PMC

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