To the Editor:
In their well conducted study, the authors have recommended the liberal use of MRI in evaluating injuries of the knee in patients
with traumatic ipsilateral hip dislocation.
We respectfully wish to make the following points regarding their findings and recommendations.
The authors have made no mention about the number of instances in which their
management plan was changed because of the identification of a knee injury,
or the number of patients for whom such factors as the length of
hospital stay,the need for continuing rehabilitation, or the clinical outcome was different because
of the knee injury.
Further, the authors have not identified
any epidemiological, clinical, or radiological factors that should be viewed as indications for proceeding with MRI evaluation of the knee. Amazingly, the
authors have made no mention about the use of a simple investigation like a
plain radiograph which can identify injuries such as PCL avulsion.
In this era of high velocity injury, we believe it is very unlikely to
fracture a single bone or dislocate a single joint without suffering
injuries to other bones, joints, or soft tissues. Another study has suggested the association of knee injuries and ipsilateral
fracture of the femur(1). Hip dislocations and femoral fractures contribute a
major proportion of lower limb fractures. Hence if we start using MRI of the knee
liberally in such patients,we will end up identifying a large number of knee abnormalities
without knowing their clinical significance or whether they were temporally related to the proximal trauma.
Hence it would be better to be judicious about the use of MRI
until we have more evidence about the outcomes of knee injuries associated with hip or femoral trauma in the form
of meta-analysis, multicentered prospective trials, and long term follow-
up studies.
Reference
1. Dickson KF, Galland MW, Barrack RL, Neitzschman HR, Harris MB,
Myers L, Vrahas MS. Magnetic resonance imaging of the knee after
ipsilateral femur fracture. J Orthop Trauma. 2002; 16:567-71.
Yours sincerely,
Mr. Senthil Nathan Sambandam
Mr. Arif Gul
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