1
|
Paulsson M, Ekholm C, Tranberg R, Rolfson O, Geijer M. Using a Traction Table for Fracture Reduction during Minimally Invasive Plate Osteosynthesis (MIPO) of Distal Femoral Fractures Provides Anatomical Alignment. J Clin Med 2023; 12:4044. [PMID: 37373737 DOI: 10.3390/jcm12124044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Fracture reduction and fixation of distal femur fractures are technically demanding. Postoperative malalignment is still commonly reported after minimally invasive plate osteosynthesis (MIPO). We evaluated the postoperative alignment after MIPO using a traction table with a dedicated femoral support. METHODS The study included 32 patients aged 65 years or older with distal femur fractures of all AO/OTA types 32 (c) and 33 (except 33 B3 and C3) and peri-implant fractures with stable implants. Internal fixation was achieved with MIPO using a bridge-plating construct. Bilateral computed tomography (CT) scans of the entire femur were performed postoperatively, and measurements of the uninjured contralateral side defined anatomical alignment. Due to incomplete CT scans or excessively distorted femoral anatomy, seven patients were excluded from analyses. RESULTS Fracture reduction and fixation on the traction table provided excellent postoperative alignment. Only one of the 25 patients had a rotational malalignment of more than 15° (18°). CONCLUSIONS The surgical setup for MIPO of distal femur fractures on a traction table with a dedicated femoral support facilitated reduction and fixation, resulting in a low rate of postoperative malalignment, despite a high rate of peri-implant fractures, and could be recommended for surgical treatment of distal femur fractures.
Collapse
Affiliation(s)
- Martin Paulsson
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Roy Tranberg
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Mats Geijer
- Department of Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Clinical Sciences, Lund University, 22185 Lund, Sweden
| |
Collapse
|
2
|
Influence of reduction quality on functional outcome and quality of life in the surgical treatment of tibial plateau fractures: A retrospective cohort study. Orthop Traumatol Surg Res 2022; 108:102922. [PMID: 33836282 DOI: 10.1016/j.otsr.2021.102922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/06/2020] [Accepted: 01/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Despite a substantial improvement in the operative treatment of tibial plateau fractures, the surgical procedure remains controversial and is generally challenging, as patients may develop postoperative arthritis and functional impairment of the knee joint. HYPOTHESIS In the surgical treatment of tibial plateau fractures the intraoperative reposition quality has the greatest influence on the postoperative outcome, whereby misalignments of≥2mm lead to a worse result. PATIENTS AND METHODS Forty-one patients with tibial plateau fractures were postoperatively examined. The operative treatment was performed under reduction control using an intraoperative 3D C-arm. The follow-up collective was divided into two groups depending on the intraoperative reduction result. The postoperative results were then evaluated using the following parameters: Lysholm score, Rasmussen score, Tegner score, SF-36 score, range of motion and pain level. RESULTS Group 1 (articular surface incongruencies<2mm) tended to achieve a better result in all scores than group 2 (articular surface incongruencies≥2mm), in the Lysholm score (p=0.039), in the comparison of the range of motion (p=0.012) and the pain level (p=0.039) this was significant. Group 1 achieved an average of 90.71 points (group 2: 78.74) in the Lysholm score. The average range of motion of the knee joint was 138.93° in group 1 (group 2: 127.78°). The average value of the current pain level in group 1 was 1.14 (group 2: 2.63). DISCUSSION Both study groups achieved a very good result compared to the available literature. It appears that reduction quality - which can be analyzed with intraoperative 3D imaging - plays the most important role in postoperative quality of life and functional outcome. Intraoperative adjustments of the reduction should therefore be performed on joint surface irregularities with a size above 2mm. LEVEL OF EVIDENCE III; retrospective case control study.
Collapse
|
3
|
Abdelmonem AH, Saber AY, El Sagheir M, El-Malky A. Evaluation of the Results of Minimally Invasive Plate Osteosynthesis Using a Locking Plate in the Treatment of Distal Femur Fractures. Cureus 2022; 14:e23617. [PMID: 35505714 PMCID: PMC9053357 DOI: 10.7759/cureus.23617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Distal femur fractures are serious injuries that can be difficult to treat, carry an unpredictable prognosis, and lead to long-term disability and morbidity. The introduction of minimally invasive plate osteosynthesis (MIPO) avoids direct exposure of the fracture site, improves fracture healing and decreases the incidence of complications. The aim of this study was to assess prospectively the early results of the treatment of supracondylar fractures of the femur using minimally invasive percutaneous osteosynthesis using a distal femoral locking plate. The study was a prospective study that included 20 adult patients who sustained distal femur fractures. Materials and methods The study was a prospective study that included 20 patients suffering from supracondylar fractures of the femur. All patients had fixation of the fracture using a distal femur locking plate (less invasive stabilization system (LISS)) in a minimally invasive technique using an anterolateral or direct lateral approach to the distal femur according to the fracture classification. The follow-up was done using the functional evaluation scale for distal femoral fractures as regards range of motion, deformation, pain, walking ability, and return to work. Results The mean age was 52.80 (19-80) years. The mean body mass index of the patients was 28.50, with a range of 23-43 kg/m2. The mechanism of trauma was road traffic accidents (RTAs) in nine patients (45%) and falling from standing height in eleven patients (55%). Fractures were classified according to the Arbeitsgemeinschaft Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) classification. All patients were followed up for a period of six months and assessed in terms of knee range of motion, deformation, pain, walking ability, and return to work. The mean time of radiological union, in which bony trabeculae crossed the fracture gap, was 3.45 ± 0.79 months. The final results obtained were excellent in four patients (20%), good in nine patients (45%), fair in five patients (25%), and poor in two patients (10%). Complications encountered were knee stiffness (20%), superficial wound infection (10%), and shortening (15%). Conclusion LISS plating using the MIPO approach is useful in treating complex distal femoral fractures. Large studies from independent centers reporting long-term results are needed to further evaluate the role of LISS plating and the MIPO approach in the management of complex distal femoral fractures.
Collapse
|
4
|
Jankowski JM, Szukics PF, Shah JK, Keller DM, Pires RE, Liporace FA, Yoon RS. Comparing Intramedullary Nailing Versus Locked Plating in the Treatment of Native Distal Femur Fractures: Is One Superior to the Other?. Indian J Orthop 2021; 55:646-654. [PMID: 33995868 PMCID: PMC8081772 DOI: 10.1007/s43465-020-00331-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/12/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Distal femur fractures make up < 1% of all fractures and 3-6% of all femur fractures. In the literature, both intramedullary nailing (IMN) and locked plating (LP) have shown favorable results, but there is no consensus on a gold standard. The purpose of this systematic review is to compare outcomes of native distal femur fractures treated via IMN versus LP in an effort to determine if one is superior to the other. METHODS Systematic review of MEDLINE, EMBASE, and Cochrane Library databases was conducted according to PRISMA guidelines. Only articles published within the last ten years were included. Evidence and study quality were evaluated with the MQOE and Oxford Criteria. RESULTS Forty-six articles were included in the review. Fractures treated with IMN were found to have a 93.9% union rate, an average time to union of 19.2 weeks, an average arc of motion of 105.1 degrees, with an average of 14.4 degrees of malalignment. Fractures treated with LP were found to have a 90.2% union rate, an average time to union of 20.5 weeks, an average arc of motion of 104 degrees, with an average of 12.6 degrees of malalignment. CONCLUSION Compiled data comparisons revealed no differences in union rate, malalignment, time to union, average arc of motion, or complication rates requiring a return to the operating room. Until higher level randomized data is available, either IMN or LP are acceptable methods of treatment for native distal femur fractures.
Collapse
Affiliation(s)
- Jaclyn M. Jankowski
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Patrick F. Szukics
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Jay K. Shah
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - David M. Keller
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Robinson E. Pires
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Felicio Rocho Hospital, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Frank A. Liporace
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Richard S. Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| |
Collapse
|
5
|
Ermutlu C, Göksel F, Eken G. Treatment of Periarticular Fractures of the Knee Using the Less Invasive Stabilization System: A Retrospective Clinical Trial. Cureus 2020; 12:e7773. [PMID: 32461848 PMCID: PMC7243630 DOI: 10.7759/cureus.7773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Periarticular fractures of the knee in adults are generally treated with internal fixation. The Less Invasive Stabilization System (LISS) plate, developed by Arbeitsgemeinschaft Osteosynthesefragen (AO)/Association for the Study of Internal Fixation (ASIF) in the late 1990s, allows reduction and biological fixation through smaller incisions without violating periosteal blood supply. It offers several advantages for the treatment of complex periarticular fractures of the knee. In this study, we have aimed to report the results of a single series of these fractures. Materials and methods Forty-eight patients with AO type 33 and AO type 41 periarticular knee fractures who were operated between 2009 and 2014 at a single institution were included in this retrospective study. Patient demographics, fracture epidemiology, intraarticular extension, concomitant injuries, American Society of Anesthesiologists (ASA) score, time to union, the average time from admission to surgery, and the mean time from operation to patient discharge were noted. The effect of patient and fracture-related factors on length of hospital stay were evaluated. Results The mean follow-up time was 23.7 (12-48) months. The average time from admission till surgery and from surgery till discharge was 10.2 (1-39) and 9.7 (2-35) days, respectively. The average time for union was 6.8 months. Femur fractures healed in mean 6.6 months whereas tibia fractures took 7.1 months to heal. Time from admission to surgery and postoperative hospital stay was longer in patients with higher ASA scores (p<0.01) and open fractures (p<0.001). Patients’ body mass index (BMI) and intraarticular extension of the fracture did not cause an increase in either preoperative or postoperative hospital stay (p>0.05). The presence of concomitant major injuries caused a delay in operation (p<0.05), whereas postoperative hospital stay was not different (p>0.05). Conclusion LISS plating provides good stability through a small incision, permits biological fracture healing, may be used in multifragmentary fractures and has low complication rates. It is a good alternative for the treatment of periarticular fractures of the knee.
Collapse
Affiliation(s)
- Cenk Ermutlu
- Orthopaedics, Bursa Uludag University School of Medicine, Bursa, TUR
| | - Ferdi Göksel
- Orthopaedics and Traumatology, Özel Karadeniz Ereğli Anadolu Hospital, Zonguldak, TUR
| | - Gökay Eken
- Orthopaedics and Traumatology, Bursa Acıbadem Hospital, Bursa, TUR
| |
Collapse
|
6
|
Tian ZJ, Liu YJ, Chen BJ, Wang J, Niu CL, Feng EH, Mai XJ, Huang YM. Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures: Three case reports. Medicine (Baltimore) 2020; 99:e19195. [PMID: 32080105 PMCID: PMC7034731 DOI: 10.1097/md.0000000000019195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RATIONALE Less-Invasive Stabilization System (LISS) plate is an internal fixation commonly used for the periprosthetic distal femur fractures. Failure associated with LISS plate has been rarely reported, and the reasons for LISS plate failure are multitudinous. Various advantages have been reported, but failures continue. PATIENT CONCERNS We present 3 cases illustrating the failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures. The shaft screws of the LISS plate broke in 2 cases, and the plate placement was incorrect in 1 case. Early weight bearing, obesity, osteoporosis, and lateral collateral ligament injury due to incorrect plate placement constituted the etiologies of LISS plate failure. DIAGNOSIS Failure of Less-Invasive Stabilization System (LISS) plating for periprosthetic distal femur fractures after Total knee arthroplasty. INTERVENTIONS Three patients underwent Less-Invasive Stabilization System plates removal with replacement of the total knee arthroplasty revision surgery with rotating hinged knee prosthesis. OUTCOMES After completing the total knee arthroplasty revision surgery, all patients underwent regular follow-up examinations. Case 2 could walk unaided, without pain, final union was confirmed for both case 1 and case 3. CONCLUSION Less-Invasive Stabilization System (LISS) plate provides satisfactory results in periprosthetic fractures after Total knee arthroplasty (TKA). The LISS plate has many advantages, but failures continue to occur. The causes for failure were early weight bearing, obesity, osteoporosis, and lateral collateral ligament (LCL) injury due to incorrect plate placement in our series. We recommend that protection or properly delay of weight-bearing, active anti-osteoporosis treatment, and intraoperative fluoroscopy are the effective methods to avoid failure.
Collapse
Affiliation(s)
- Zhen-Jiang Tian
- Department of Orthopedic Surgery, Guangzhou University of Traditional Chinese Medicine, Guangzhou City
| | - Yan-Jie Liu
- Department of Orthopedic Surgery, Guangzhou University of Traditional Chinese Medicine, Guangzhou City
| | - Bo-Jian Chen
- Department of Orthopedic Surgery, Guangzhou University of Traditional Chinese Medicine, Guangzhou City
| | - Jun Wang
- Department of Orthopedic Surgery, Guangzhou University of Traditional Chinese Medicine, Guangzhou City
| | - Cai-Li Niu
- Department of Orthopedic Surgery, Guangzhou University of Traditional Chinese Medicine, Guangzhou City
| | - En-Hui Feng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou,Guangdong Province, People's Republic of China
| | - Xiu-Jun Mai
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou,Guangdong Province, People's Republic of China
| | - Yong-Ming Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou,Guangdong Province, People's Republic of China
| |
Collapse
|
7
|
Norris GR, Checketts JX, Scott JT, Vassar M, Norris BL, Giannoudis PV. Prevalence of Deep Surgical Site Infection After Repair of Periarticular Knee Fractures: A Systematic Review and Meta-analysis. JAMA Netw Open 2019; 2:e199951. [PMID: 31441940 PMCID: PMC6714463 DOI: 10.1001/jamanetworkopen.2019.9951] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IMPORTANCE Surgical management of periarticular knee fractures can be challenging, and adverse outcomes may be severe. Recent literature indicates that the rate of periarticular knee surgical site infection (SSI) may range from 2% to 88% depending on the fracture site. OBJECTIVE To examine the prevalence of deep SSI and the rate of septic arthritis after surgical repair of fractures around the knee. DATA SOURCES The electronic databases MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to July 1, 2018. STUDY SELECTION Eligible studies had to specifically report deep SSI rates and include fractures in the distal femur, patella, tibial plateau, or proximal tibia. Risk factors that were associated with increased the risk of deep SSI were also examined. DATA EXTRACTION AND SYNTHESIS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were extracted by multiple investigators. Comprehensive Meta-Analysis software was used for the pooling of data, using either random-effects or fixed-effects models, with respect to the degree of statistical heterogeneity present. Data analyses were conducted in October 2019. MAIN OUTCOMES AND MEASURES The primary outcome was overall prevalence of deep SSI after periarticular knee fracture repair. The secondary outcomes were the overall prevalence of septic arthritis, risk factors associated with deep SSI, and the most commonly cultured bacteria specimens found periarticular knee infections. RESULTS Of 6928 articles screened, 117 articles met inclusion criteria and were included in analysis. Among 11 432 patients included in analysis, 653 patients (5.7%) experienced deep SSIs, most commonly among patients with proximal tibia fractures (56 of 872 patients [6.4%]). Among studies that included information on septic arthritis, 38 of 1567 patients (2.4%) experienced septic arthritis. The 2 most commonly reported bacteria were methicillin-resistant Staphylococcus aureus, found in 67 SSIs, and methicillin-susceptible S aureus, found in 53 SSIs. Sixty-two studies (53.0%) in the sample received a Coleman Methodological Score of poor (<50 points). CONCLUSIONS AND RELEVANCE Deep SSIs occurred in nearly 6% of periarticular knee fracture repairs, and 2.4% of SSIs were associated with septic arthritis. Surgeons managing these injuries should be vigilant when wounds are not pristine. Efforts should be made to elevate the quality of research conducted not only in this subject but also in orthopedic surgery as a whole.
Collapse
Affiliation(s)
| | | | - Jared T. Scott
- Oklahoma State University Center for Health Sciences, Tulsa
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
| | - Matt Vassar
- Oklahoma State University Center for Health Sciences, Tulsa
| | - Brent L. Norris
- Department of Orthopedics, Oklahoma State University Center for Health Sciences, Tulsa
- Orthopedic & Trauma Services of Oklahoma, Tulsa
| | | |
Collapse
|
8
|
Freimoser F, Grechenig S, Ofenhitzer A, Bakota B, Staresinic M, Pfeifer CG. Anatomical and radiological evaluation of less invasive stabilisation system (LISS) in correlation with knee lateral collateral ligament insertion. Injury 2017; 48 Suppl 5:S56-S60. [PMID: 29122124 DOI: 10.1016/s0020-1383(17)30741-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Less Invasive Stabilisation System (LISS) is an angle-stable plate that enables treatment of distal femoral comminuted and periprosthetic fracture. As it is placed through a minimally-invasive lateral approach, lateral knee pain is a commonly described symptom after its application. This study investigates knee lateral collateral ligament (LCL) iatrogenic injury during LISS plate fixation. A cadaver study was performed and a retrospective radiological investigation with the analysis of its clinical application was conducted to evaluate possible knee LCL damage. METHODS The cadaver study included 13 human lower extremities, treated with LISS. After application, lateral knee side was dissected, implants were removed and distances between the drill holes and LCL origin were measured. In the retrospective radiological evaluation, postoperative X-rays for patients treated with distal femoral LISS plate in the University Hospital Regensburg, Germany from January 2010 to December 2015 were examined. Following a protocol described by Pietrini et al., the LCL origin on postoperative X-rays was calculated, both in lateral and anterior-posterior (AP) view, and distances between the plate and its closest locking screw to the LCL origin were measured. RESULTS In the cadaver study, the mean distance between the closest drilling hole and the ligament origin was 14.0mm (range 9-21mm; SD 3.8mm). Twenty-two patients matched the inclusion criteria for the retrospective radiological study. In lateral view, the mean distance between the origin and the closest locking screw was 6.3mm (range 0-16.4mm; SD 4.7mm); the mean distance between the origin and the plate was 3.1mm (range 0-13.9mm; SD 4.1mm). In AP view, the mean distance between LCL origin and the nearest screw was 2.4mm (range 0-7.6mm; SD 2.4mm). The mean distance between the origin and the most distal locking screw was 9.2mm (range 0-17.5mm; SD 4.0mm). DISCUSSION The LISS is a safe option to treat distal femoral fractures in respect to the LCL. Due to close proximity, the LCL might be harmed; therefore, lateral knee pain or lateral instability after implantation should be assessed in further treatment.
Collapse
Affiliation(s)
- Florian Freimoser
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany
| | - Stephan Grechenig
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany
| | - Anna Ofenhitzer
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany
| | - Bore Bakota
- Trauma and Orthopaedic Surgery department, Brighton and Sussex University Hospital, NHS Trust, UK
| | - Mario Staresinic
- Trauma and Orthopaedic Clinic, University Hospital Merkur, Zagreb, Croatia
| | - Christian G Pfeifer
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany.
| |
Collapse
|
9
|
Kortram K, Bezstarosti H, Metsemakers WJ, Raschke MJ, Van Lieshout EM, Verhofstad MH. Risk factors for infectious complications after open fractures; a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2017; 41:1965-1982. [DOI: 10.1007/s00264-017-3556-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/23/2017] [Indexed: 01/20/2023]
|
10
|
Bertrand M, Andrés-Cano P, Pascual-López F. Periarticular Fractures of the Knee in Polytrauma Patients. Open Orthop J 2015; 9:332-46. [PMID: 26312118 PMCID: PMC4541416 DOI: 10.2174/1874325001509010332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/26/2015] [Accepted: 05/18/2015] [Indexed: 12/20/2022] Open
Abstract
Periarticular fractures around the knee are a challenge for the orthopaedic surgeon. When these fractures are presented in the context of a multiple trauma patient, they are even more difficult to manage because the treatment approach depends not only on the fracture itself, but also on the patient's general condition. These fractures, caused by high-energy trauma, present complex fracture patterns with severe comminution and major loss of articular congruity, and are often associated with vascular and nerve complications, particularly in the proximal tibia, due to its anatomical features with poor myocutaneous coverage. They are almost always accompanied by soft tissue injury. The management of polytrauma patients requires a multidisciplinary team and accurate systemic stabilization of the patient before undertaking orthopaedic treatment. These fractures are usually addressed sequentially, either according to the general condition of the patient or to the local characteristics of the lesions. In recent decades, various fixation methods have been proposed, but there is still no consensus as to the ideal method for stabilizing these fractures. In this paper, we describe the general characteristics of these fractures, the stabilization methods traditionally used and those that have been developed in recent years, and discuss the treatment sequences proposed as most suitable for the management of these injuries.
Collapse
Affiliation(s)
- M.L. Bertrand
- Department of Orthopaedic Surgery and Traumatology. Hospital Costa del Sol. University of Malaga, Spain
| | | | | |
Collapse
|
11
|
Jöckel JA, Erhardt J, Vincenti M, Reissig J, Hoffmann R, Husain B, Täger G, Partenheimer A, Lill H, Gebhard F, Röderer G. Minimally invasive and open surgical treatment of proximal tibia fractures using a polyaxial locking plate system: a prospective multi-centre study. INTERNATIONAL ORTHOPAEDICS 2013; 37:701-8. [PMID: 23417521 DOI: 10.1007/s00264-013-1820-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 01/29/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to determine whether a polyaxial locking plate of the latest generation (NCB PT(®), Zimmer Inc.) which can be applied both open and minimally invasively, can be used as a routine method of treatment for proximal tibia fractures. METHODS Eighty-six patients (35 women, 51 men; mean age 51 years) were enrolled in this prospective multicentre trial. Ninety-six percent of the fractures were intra-articular (AO type B and C); 36 % were treated open and 64 % minimally invasively. Follow-up was obtained three, six and 12 months after surgery. RESULTS No implant failure occurred. At 12 months, the functional result using a knee-specific score was good to excellent in 95 %, and 99 % of the fractures were radiologically healed. CONCLUSION The system is a versatile implant for proximal tibia fracture treatment. Polyaxiality and a specific locking mechanism are compatible with different fracture patterns. The minimally invasive technique effectively protects soft tissues but should not be performed at the expense of fracture reduction. Early functional results and complication rate are comparable to those in the literature.
Collapse
Affiliation(s)
- Jens A Jöckel
- Orthopaedic Trauma, Ulm University, Albert-Einstein-Allee 23, 80981, Ulm, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma 2012; 26:327-32. [PMID: 22183200 DOI: 10.1097/bot.0b013e318234d460] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES In the distal femur, locked plating is efficacious when coronal fractures preclude the use of a conventional fixed-angle device. However, minimal comparative data exist for supracondylar fracture patterns, which could be treated with other devices. The purpose of this study was to compare the 95-degree angled blade plate (ABP) versus the Locking Condylar Plate (LCP) by assessing complications and secondary procedures in fractures amenable to treatment with either implant. DESIGN Retrospective review. SETTING Level 1 trauma center. PATIENTS/PARTICIPANTS Seventy patients with 71 distal femoral fractures (OTA 33-A, 33-C1, 33-C2) amenable to either ABP or LCP with a mean age of 59.5 years (range, 20-92 years) were included. Seventeen fractures (24%) occurred adjacent to a previous knee arthroplasty (10 ABP and 7 LCP). The 2 groups were similar with respect to age, fracture pattern, and the presence of open fracture. Most injuries were the result of high-energy trauma, and 21% were open fractures. INTERVENTION Thirty-two fractures (45%) were treated with an ABP, and 39 (55%) were treated with the LCP. MAIN OUTCOME MEASURES Complications, including infection, nonunion, and malunion, and secondary operations were determined. RESULTS After a mean of 26-month follow-up, 4 patients (6.0%) were treated for infections. Malunions occurred in 11% of LCP patients and in 1 ABP patient (3.4%, P = 0.14). All patients with malunions were older than 55 years. Seven patients (11%) were treated for nonunions. Six of the nonunions occurred after LCP (16% vs. 3.4%, P = 0.11) Complications were more frequent in LCP patients (35%) versus ABP patients (10%, P = 0.001). Complications were not related to fracture pattern, periprosthetic fracture, or open fracture. Mean age of patients with complications was 64 years (vs. 53 years, P = 0.01), and they were more likely to have lower energy mechanisms (P = 0.017). Overall, 18 patients (27%) underwent secondary procedures, including treatment of infection, nonunion, malunion, or prominent implant removal. Secondary procedures were more common after LCP (43%) versus ABP (6.9%, P = 0.0008) patients. Painful prominent implants were removed from 7 LCP patients (18%) and no ABP patients (P = 0.01). CONCLUSIONS Distal femur fractures are often associated with prolonged healing and rehabilitation times, which increase substantially when complications occur. Internal fixation of these fractures may be performed successfully with ABP or LCP. In our review of fractures that could be treated with either implant, patients treated with locking plates had more complications and nonunions, requiring more secondary procedures to treat complications and to remove prominent implants. Furthermore, locking plates are substantially more expensive than conventional fixed-angle devices. Future investigation is needed in the form of a large randomized prospective study to clearly define clinical differences, functional outcomes, and costs of care. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
13
|
Treatment of ipsilateral concomitant fractures of proximal extra capsular and distal femur. Injury 2011; 42:675-81. [PMID: 21176901 DOI: 10.1016/j.injury.2010.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/20/2010] [Accepted: 11/10/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Ipsilateral concomitant fractures of proximal extracapsular and distal femur are rare injuries and pose a great challenge for orthopaedics. In this study, we reviewed and examined the approaches and outcomes of this complex injury. METHODS From August 2002 to January 2010, seven patients (six males and one female) with a mean age of 39 years (range, 20-48 years) were involved in the study. They had suffered from ipsilateral concomitant fractures of proximal extracapsular and distal femur, with two cases of unstable intertrochanteric fractures, three cases of subtrochanteric fractures and two cases of extracapsular femoral neck fractures. The distal femoral fractures were categorised based on the Arbeitsgemeinschaft für Osteosynthes (AO) classification: 2, A3; 2, C1; 2, C2 and 1, C3, and the proximal femoral fractures were stabilised via nailing, whilst the distal ones via less-invasive stabilisation system-distal femur (LISS-DF) plating in all six patients. In the one with the 'floating knee' injury, the subtrochanteric fracture was stabilised by reversed LISS-DF, and the distal one, by retrograde nailing. The healing of each femoral fracture was evaluated radiologically and clinically with follow-up. The functional outcomes were assessed through the Friedman and Wyman system. RESULTS The mean follow-up interval was 2 years (range, 1.5-3 years). Six femoral fractures healed uneventfully, whilst the one with the 'floating knee' injury developed a delayed union postoperatively due to metal failure in 6 months, and, eventually, a malunion with coxa vara deformity 1.5 years later. The clinical functions at the final follow-up were found to be good in five cases, and fair and poor in one case each. CONCLUSION The nailing of a proximal femoral fracture and an LISS-DF fixation of a distal one could be a reliable and effective approach to handle ipsilateral concomitant fractures of a proximal extracapsular and distal femur.
Collapse
|
14
|
Minimally invasive plate osteosynthesis of tibial fracture using self-navigated plate. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0783-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
15
|
Intramedullary nailing of proximal tibia fractures--an anatomical study comparing three lateral starting points for nail insertion. Injury 2010; 41:220-5. [PMID: 19880112 DOI: 10.1016/j.injury.2009.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 09/13/2009] [Accepted: 10/05/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Intramedullary nailing is challenging in proximal tibia fractures, associated with high rates of malalignment. To date, no studies report the potential of lateral tibia nail insertion to correct primary valgus malalignment, commonly seen in proximal quarter fractures. MATERIALS AND METHODS 18 fresh-frozen cadaver lower extremities were used to simulate an AO/OTA 41-A3 fracture. Six nails (Expert Tibial Nailing System, Synthes, Salzburg, Austria) were inserted at the lateral third, six nails at the middle third and six nails at the medial third of the lateral tibia plateau. After nail insertion, alignment in the coronal plane was recorded. RESULTS Mean varus malalignment was dependent on the entry point at the lateral tibia plateau. Mean varus malalignment was 16 degrees if nails were inserted at the lateral third, 10 degrees at the middle third and 4 degrees after nail insertion at the medial third. If nails were inserted from the medial third, valgus malalignment was recorded in two specimens. DISCUSSION The effect of correction of coronal malalignment in proximal tibia fractures is dependent on the point of nail entry at the lateral plateau. Primary valgus deformation up to 20 degrees can be corrected by inserting tibia nails at the lateral third of the lateral tibia plateau. Surgeons should be aware of possible varus deformity and valgus malalignment despite lateral nail insertion.
Collapse
|