1
|
Saraglis G, Khan A, Sharma A, Pyakurel S, Rabbani SFE, Arafa MSA. The linked nail/plate construct for the management of distal femur fractures in the elderly. SICOT J 2024; 10:20. [PMID: 38819290 PMCID: PMC11141519 DOI: 10.1051/sicotj/2024016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Distal femoral fractures represent a challenging injury, with many different factors such as the method of fixation, complexity of fracture pattern, and patient co-morbidities affecting the outcome. Lots of surgical treatment options have been described, but recently double construct fixation, using a nail/plate combination, has received lots of attention, a technique that leads to faster weight-bearing, low risk of metalwork failure, and non-union. The purpose of this study was to investigate the effectiveness of the linked nail/plate construct in the management of complex distal femur fractures and to investigate if the above technique leads to faster recovery and earlier radiographic union. MATERIALS AND METHODS In total 15 cases were included in the study, that underwent a combined nail/plate construct for a distal femur fracture between January 2021 and December 2022. Only cases with a linked nail/plate construct were included, with a minimum follow-up of 1 year. Open femur fractures, single implant fixation cases, and revision procedures were excluded. RESULTS In this cohort study, 11 cases were periprosthetic distal femur features, and 4 cases were distal femur fractures around a native knee joint. The mean age group was 74 years, 86.6% of the patients had a BMI > 25 and the mean time to fracture union was 24 weeks (range from 20 to 26 weeks). All cases healed uneventfully and the complication rate was 6.6%, including 1 case of superficial infection which resolved completely with oral antibiotics. CONCLUSION The increasing age population, the complexity of distal femoral fractures along with the increasing physiological demands of the elderly population, drive the need for double fixation constructs that allow early mobilization and enhance fracture stability. In our study, the linked nail/plate construct seems to provide adequate stability and excellent union rates (100%) with no associated increased risk of complications.
Collapse
Affiliation(s)
- Georgios Saraglis
- Department of Trauma and Orthopaedics, Bedfordshire NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road Bedford MK429DJ United Kingdom
| | - Anwar Khan
- Department of Trauma and Orthopaedics, Bedfordshire NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road Bedford MK429DJ United Kingdom
| | - Amit Sharma
- Department of Trauma and Orthopaedics, Bedfordshire NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road Bedford MK429DJ United Kingdom
| | - Sagar Pyakurel
- Department of Trauma and Orthopaedics, Bedfordshire NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road Bedford MK429DJ United Kingdom
| | - Sayed Fazal Elahi Rabbani
- Department of Trauma and Orthopaedics, Bedfordshire NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road Bedford MK429DJ United Kingdom
| | - Mohamed Shawky Abdelhamid Arafa
- Department of Trauma and Orthopaedics, Bedfordshire NHS Foundation Trust, Bedford Hospital South Wing, Kempston Road Bedford MK429DJ United Kingdom
| |
Collapse
|
2
|
Wardle B, Lynch JT, Staniforth T, Ward T, Smith P. Weightbearing versus non-weight bearing in geriatric distal femoral fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02550-7. [PMID: 38777887 DOI: 10.1007/s00068-024-02550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Demographics of patients who sustain geriatric distal femoral fractures (DFF) match those of patients with neck-of-femur fractures but have limited evidence with which to support post-operative weightbearing protocols. PURPOSE This systematic review sought to identify any difference in outcomes for elderly patients with DFF who were allowed early versus delayed weightbearing postoperatively. METHODS DATA SOURCES: PubMed, Medline, Embase and The Cochrane Library, reference lists of retrieved articles. STUDY SELECTION English language papers published between January 2010 and February 2023 with AO-OTA type 33A, B and C femoral fractures as well as Lewis and Rorabeck Type I and II periprosthetic DFF surgically treated with either a lateral locking plate or retrograde intramedullary nail and an average patient age of ≥ 60 years. DATA EXTRACTION Studies were assessed for inclusion by two authors and quality was assessed using the MINORS tool. DATA SYNTHESIS Sixteen studies were included, Meta-analysis of non-union, malunion, infection, delayed union and implant complications was performed using Microsoft Excel and the MetaXL extension. The data on return to mobility were presented in narrative form. The analyses demonstrated no difference between the early and delayed weightbearing groups. CONCLUSIONS There are no significant differences in complication rates between early versus delayed weightbearing after surgery for DFF in an elderly population. The study results are limited by high heterogeneity and low-quality studies. High quality, prospective studies are needed to determine the ideal postoperative weightbearing protocol. LEVEL OF EVIDENCE Level III, Systematic Review and Meta-analysis of Level III studies. International Prospective Register of Systematic Reviews registration-Prospero CRD42022371460.
Collapse
Affiliation(s)
- Blaise Wardle
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia.
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia.
- The Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Joseph T Lynch
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Thomas Staniforth
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
| | - Thomas Ward
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
3
|
Van Rysselberghe NL, Seltzer R, Lawson TA, Kuether J, White P, Grisdela P, Daniell H, Amirhekmat A, Merchan N, Seaver T, Samineni A, Saiz A, Ngo D, Dorman C, Epner E, Svetgoff R, Terle M, Lee M, Campbell S, Dikos G, Warner S, Achor T, Weaver MJ, Tornetta P, Scolaro J, Wixted JJ, Weber T, Bellino MJ, Goodnough LH, Gardner MJ, Bishop JA. Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study. J Orthop Trauma 2024; 38:57-64. [PMID: 38031262 DOI: 10.1097/bot.0000000000002730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES To compare clinical and radiographic outcomes after retrograde intramedullary nailing (rIMN) versus locked plating (LP) of "extreme distal" periprosthetic femur fractures, defined as those that contact or extend distal to the anterior flange. METHODS DESIGN Retrospective review. SETTING Eight academic level I trauma centers. PATIENT SELECTION CRITERIA Adult patients with periprosthetic distal femur fractures at or distal to the anterior flange (OTA/AO 33B-C[VB1]) treated with rIMN or LP. OUTCOME MEASURES AND COMPARISONS The primary outcome was reoperation to promote healing or to treat infection (reoperation for elective removal of symptomatic hardware was excluded from this analysis). Secondary outcomes included nonunion, delayed union, fixation failure, infection, overall reoperation rate, distal femoral alignment, and ambulatory status at final follow-up. Outcomes were compared between patients treated with rIMN or LP. RESULTS Seventy-one patients treated with rIMN and 224 patients treated with LP were included. The rIMN group had fewer points of fixation in the distal segment (rIMN: 3.5 ± 1.1 vs. LP: 6.0 ± 1.1, P < 0.001) and more patients who were allowed to weight-bear as tolerated immediately postoperatively (rIMN: 45%; LP: 9%, P < 0.01). Reoperation to promote union and/or treat infection was 8% in the rIMN group and 16% in the LP group ( P = 0.122). There were no significant differences in nonunion ( P > 0.999), delayed union ( P = 0.079), fixation failure ( P > 0.999), infection ( P = 0.084), or overall reoperation rate ( P > 0.999). Significantly more patients in the rIMN group were ambulatory without assistive devices at final follow-up (rIMN: 35%, LP: 18%, P = 0.008). CONCLUSIONS rIMN of extreme distal periprosthetic femur fractures has similar complication rates compared with LP, with a possible advantage of earlier return to weight-bearing. Surgeons can consider this treatment strategy in all fractures with stable implants and amenable prosthesis geometry, even extreme distal fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Noelle L Van Rysselberghe
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA
| | - Ryan Seltzer
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Taylor A Lawson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Justin Kuether
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Parker White
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Phillip Grisdela
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hayley Daniell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Arya Amirhekmat
- Department of Orthopaedic Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - Nelson Merchan
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Thomas Seaver
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA
| | - Aneesh Samineni
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA
| | - Augustine Saiz
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Daniel Ngo
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Clark Dorman
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Eden Epner
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Reese Svetgoff
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Megan Terle
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Mark Lee
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Sean Campbell
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA
| | - Gregory Dikos
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Stephen Warner
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Timothy Achor
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health, Houston, TX; and
| | - Michael J Weaver
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul Tornetta
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, MA
| | - John Scolaro
- Department of Orthopaedic Surgery, University of California, Irvine School of Medicine, Orange, CA
| | - John J Wixted
- Carl J. Shapiro Department of Orthopaedic Surgery and Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Timothy Weber
- OrthoIndy Trauma, St. Vincent Trauma Center, Indianapolis, IN
| | - Michael J Bellino
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - L Henry Goodnough
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
4
|
Cheng TA, Lai PH, Chuang HC, Hsu KL, Kuan FC, Su WR, Hong CK. Predictors of in-hospital mortality in older patients undergoing distal femur fracture surgery: A case-control study. SICOT J 2023; 9:36. [PMID: 38059859 DOI: 10.1051/sicotj/2023035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION Geriatric fractures including distal femur and hip fractures are associated with high mortality rates. Currently, prognostic factors for in-hospital postoperative mortality are not identified. We aimed to evaluate overall in-hospital mortality and related potential risk factors in elderly patients who underwent distal femur fracture surgery. MATERIALS AND METHODS A retrospective cohort study of patients older than 60 years, who underwent distal femur fracture surgery between January 01, 2003, and December 31, 2021, was conducted. A case-control study was conducted to compare two age-matched groups of elderly patients of equivalent ages at a 1:4 ratio. The in-hospital mortality rate was calculated and potential confounders were compared between groups. RESULTS A total of 170 patients were enrolled; five died during hospital stay after undergoing surgery, yielding a 2.94% in-hospital mortality rate. Twenty patients who did not die were included in the control group. Patients' demographics were similar. The case-control comparison showed that the time from injury to surgery, preoperative hemoglobin level, estimated glomerular filtration rate (eGFR), and white blood cell count were significant factors correlated with in-hospital mortality. DISCUSSION The overall in-hospital mortality rate was 2.94%. Significant risk factors for in-hospital mortality included a longer time from injury to surgery, lower preoperative hemoglobin level and eGFR, and higher preoperative white blood cell count. In conclusion, preoperative comprehensive geriatric assessment, including cognitive, nutritional, and frailty status, should also be considered in the elderly fracture care model.
Collapse
Affiliation(s)
- Ting-An Cheng
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Hsuan Lai
- Department of Family Medicine and Community Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan - Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan - Department of Orthopaedic Surgery, National Cheng Kung University Hospital, Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
| |
Collapse
|
5
|
Dong W, Lisitano LSJ, Marchand LS, Reider LM, Haller JM. Weight-bearing Guidelines for Common Geriatric Upper and Lower Extremity Fractures. Curr Osteoporos Rep 2023; 21:698-709. [PMID: 37973761 DOI: 10.1007/s11914-023-00834-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to summarize current weight-bearing guidelines for common geriatric fractures, around weight-bearing joints, of the upper and lower extremities. RECENT FINDINGS There is an increasing amount of literature investigating the safety and efficacy of early weight-bearing in geriatric fractures, particularly of the lower extremity. Many recent studies, although limited, suggest that early weight-bearing may be safe for geriatric distal femur and ankle fractures. Given the limited data pertaining to early weight-bearing in geriatric fractures, it is difficult to establish concrete weight-bearing guidelines in this population. However, in the literature available, early weight-bearing appears to be safe and effective across most injuries. The degree and time to weight-bearing vary significantly based on fracture type and treatment method. Future studies investigating postoperative weight-bearing protocols should focus on the growing geriatric population and identify methods to address specific barriers to early weight-bearing in these patients such as cognitive impairment, dependence on caregivers, and variations in post-acute disposition.
Collapse
Affiliation(s)
- Willie Dong
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Leonard S J Lisitano
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lucas S Marchand
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Lisa M Reider
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Justin M Haller
- Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
6
|
Albayrak K, Misir A, Alpay Y, Buyuk AF, Akpinar E, Gursu SS. Effect of fracture level on the residual fracture gap during tibial intramedullary nailing for tibial shaft fractures. SICOT J 2023; 9:26. [PMID: 37565988 PMCID: PMC10416760 DOI: 10.1051/sicotj/2023023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023] Open
Abstract
INTRODUCTION The development of fracture gap during intramedullary nailing in tibial fractures is associated with poor fracture fragment contact and increased time to union and complications. This study aimed to evaluate the effect of the fracture level in the development of the fracture gap and the effect of the fracture gap on pain, radiologic and functional outcomes, and complication rate. MATERIAL AND METHOD A total of 45 patients who underwent reamed intramedullary nailing due to closed transverse or short oblique tibial shaft fractures were divided into the proximal fracture group and the distal fracture group. The correlations between the visual analog scale (VAS) score, modified radiograph union score for tibias (RUST), and postoperative 1-year lower extremity functional scale scores, residual fracture gap, and time to union were evaluated. RESULTS The mean fracture gap amounts in the immediate postoperative anteroposterior and lateral radiographs were 5.6 ± 1.7 and 6.0 ± 1.7 mm in proximal fractures and 0.3 ± 2.4 mm and 0.4 ± 2.3 mm in distal fractures, respectively (p < 0.001 and p < 0.001, respectively). The mean time to union was 21.9 ± 2.9 weeks in the proximal fracture group and 16.7 ± 2.4 weeks in the distal fracture group (p < 0.000). The residual fracture gap amount significantly correlated with the level of fracture (r = 0.811, p < 0.001). DISCUSSION Tibial shaft fractures proximal to the isthmus level tend to develop significantly larger fracture gaps than distal fractures. It is associated with increased time to union and radiographic union scores as well as slightly higher complication and reoperation rates.
Collapse
Affiliation(s)
- Kutalmis Albayrak
- University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology 34470 Istanbul Turkey
| | - Abdulhamit Misir
- Private Safa Hospital, Department of Orthopaedics and Traumatology 34194 Istanbul Turkey
| | - Yakup Alpay
- Bahçeşehir University, Vm Medical Park Maltepe Hospital 34846 Istanbul Turkey
| | - Abdul Fettah Buyuk
- University of Missouri, Department of Orthopaedics Columbia MO 65201 USA
| | - Evren Akpinar
- University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology 34470 Istanbul Turkey
| | - Sukru Sarper Gursu
- Professor, University of Health Sciences Baltalimani Bone Diseases Training and Research Hospital, Department of Orthopaedics and Traumatology 34470 Istanbul Turkey
| |
Collapse
|
7
|
Wilson JL, Squires M, McHugh M, Ahn J, Perdue A, Hake M. The geriatric distal femur fracture: nail, plate or both? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03337-5. [PMID: 35895117 DOI: 10.1007/s00590-022-03337-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
Surgical fixation of distal femur fractures in geriatric patients is an evolving topic. Unlike hip fractures, treatment strategies for distal femur fractures are ill-defined and lack substantive high-quality evidence. With an increasing incidence and an association with significant morbidity and mortality, it is essential to understand existing treatment options and their supporting evidence. Current fixation methods include the use of either retrograde intramedullary nails, or plate and screw constructs. Due to the variability in fracture patterns, the unique anatomy of the distal femur, and the presence or absence or pre-existing implants, decision-making as to which method to use can be challenging. Recent literature has sought to describe the advantages and disadvantages of each, however, there is currently no consensus on a standard of care, and little randomized evidence is available that directly compares intramedullary nails with plating. Future randomized studies comparing intramedullary nails with plating constructs are necessary in order to develop a standard of care based on injury characteristics.
Collapse
Affiliation(s)
- Jenna L Wilson
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA.
| | - Mathieu Squires
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Michael McHugh
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Jaimo Ahn
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Aaron Perdue
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| | - Mark Hake
- Orthopaedic Surgery Department, 1500 East Medical Center Drive, TC2912, SPC 5328, Ann Arbor, MI, 48109, USA
| |
Collapse
|
8
|
Paulsson M, Ekholm C, Jonsson E, Geijer M, Rolfson O. Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial. Geriatr Orthop Surg Rehabil 2022; 12:21514593211055889. [PMID: 35145761 PMCID: PMC8822340 DOI: 10.1177/21514593211055889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.
Collapse
Affiliation(s)
- Martin Paulsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Ekholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eythor Jonsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Geijer
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ola Rolfson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
9
|
To Fix or Revise: Differences in Periprosthetic Distal Femur Fracture Management Between Trauma and Arthroplasty Surgeons. J Am Acad Orthop Surg 2022; 30:e17-e24. [PMID: 34288890 DOI: 10.5435/jaaos-d-20-00968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 05/23/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION This study sought to determine the effect of trauma fellowship training on the surgical decision to fix or revise to distal femoral replacement in periprosthetic distal femur fractures. METHODS An anonymous online survey including nine cases of geriatric periprosthetic distal femur fractures was distributed through the Orthopaedic Trauma Association website. Respondents were asked whether they would recommend fixation or revision to distal femoral replacement. Fractures were classified by the location relative to the anterior flange (proximal or distal) and the presence or absence of comminution. Recommendations were compared between type of fellowship completed (trauma, arthroplasty, or both), practice setting, and number of periprosthetic distal femur fractures treated monthly. RESULTS One hundred fifty-one surgeon survey responses were included. Completion of a trauma fellowship was associated with a higher likelihood of recommending fixation for any periprosthetic distal femur fracture compared with arthroplasty training (odds ratio [OR] 2.55, 95% confidence interval [CI] 1.97 to 3.29; P < 0.0001). Disagreement was significant for comminuted proximal (OR 6.90, 95% CI 3.24 to 14.68; P < 0.0001), simple distal (OR 20.90, 95% CI 6.41 to 67.71; P < 0.001), and comminuted distal fractures (OR 2.47, 95% CI 1.66 to 3.68; P < 0.0001). Dual fellowship-trained surgeons were less likely to recommend fixation than surgeons who completed a trauma fellowship alone (OR 0.60, 95% CI 0.39 to 0.93; P = 0.027) and more likely to recommend fixation than surgeons who completed an arthroplasty fellowship alone (OR 1.70, 95% CI 1.13 to 2.63; P = 0.012). Surgeons who treat three or more periprosthetic distal femur fractures monthly showed a significant preference for fracture fixation compared with lower volume surgeons (OR 2.45, 95% CI 1.62 to 3.68; P < 0.0001). DISCUSSION Fellowship-trained trauma surgeons show a notable preference for fracture fixation over distal femoral replacement for periprosthetic distal femur fractures, as compared with arthroplasty-trained surgeons. Additional research is needed to clarify surgical indications that maximize outcomes for these injuries.
Collapse
|
10
|
Distal Femur Replacement Versus Open Reduction and Internal Fixation for Treatment of Periprosthetic Distal Femur Fractures: A Systematic Review and Meta-Analysis. J Orthop Trauma 2022; 36:1-6. [PMID: 34001801 DOI: 10.1097/bot.0000000000002141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare complications and functional outcomes of treatment with primary distal femoral replacement (DFR) versus open reduction and internal fixation (ORIF). DATA SOURCES PubMed, Embase, and Cochrane databases were searched for English language studies up to May 19, 2020, identifying 913 studies. STUDY SELECTION Studies that assessed complications of periprosthetic distal femur fractures with primary DFR or ORIF were included. Studies with sample size ≤5, mean age <55, nontraumatic indications for DFR, ORIF with nonlocking plates, native distal femoral fractures, or revision surgeries were excluded. Selection adhered to the PRISMA criteria. DATA EXTRACTION Study quality was assessed using previously reported criteria. There were 40 Level IV studies, 17 Level III studies, and 1 Level II study. DATA SYNTHESIS Fifty-eight studies with 1484 patients were included in the meta-analysis. Complications assessed {incidence rate ratio [IRR] [95% confidence interval (CI)]: 0.78 [0.59-1.03]} and reoperation or revision [IRR (95% CI): 0.71 (0.49-1.04)] were similar between the DFR and ORIF cohorts. The mean knee range of motion was greater in the ORIF cohort (DFR: 90.47 vs. ORIF: 100.36, P < 0.05). The mean Knee Society Score (KSS) (DFR: 79.41 vs. ORIF: 82.07, P = 0.35) and return to preoperative ambulatory status were similar [IRR (95% CI): 0.82 (0.48-1.41)]. CONCLUSIONS In comparing complications among patients treated for periprosthetic distal femur fracture with DFR or ORIF, there was no difference between the groups. There were also no differences in functional outcomes, although knee range of motion was greater in the ORIF group. This systematic review and meta-analysis highlights the need for future prospective trials evaluating the outcomes of these divergent treatment strategies. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
11
|
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
|
12
|
Yoon BH, Park IK, Kim Y, Oh HK, Choo SK, Sung YB. Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta-analysis. Arch Orthop Trauma Surg 2021; 141:225-233. [PMID: 32388648 DOI: 10.1007/s00402-020-03463-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Nonunion is the most frequent cause of reoperation and is associated with high morbidity after distal femur fracture (DFF). We examined the rates of nonunion requiring reoperation after fixation for DFF using a locking compression plate (LCP) or retrograde intramedullary nail (RIMN). METHODS We included four studies comparing LCP and RIMN and 38 single-cohort studies reporting LCP or RIMN. In total, 2156 femurs were included and 166 non-unions were detected. We conducted a pair-wise meta-analysis (with a fixed-effects model) on the four comparative studies and a proportional meta-analysis on the 38 articles to estimate the nonunion rate. We performed sensitivity analysis by comparing studies using LCP with less invasive surgical systems (LISS) with those that used RIMN. RESULTS The pairwise meta-analysis showed a similar nonunion rate between the groups [odds ratio: 1.02; 95% confidence interval (CI) 0.94-1.11, p = 0.633]. According to proportional meta-analysis, the pooled prevalence of nonunion was 5% (95% CI 4-7) totally, 6% (95% CI 4-8) in the LCP group, and 4% (95% CI 2-6) in the RIMN group (heterogeneity: p = 0.105). According to the sensitivity analysis, there was no difference in the union rate. The pooled prevalence of nonunion from sensitivity analysis was 4 % (95% CI, 3-5); it was 4% (95% CI, 3-6) in LCP with LISS and was 4% (95% CI, 2-6) in RIMN group (heterogeneity: p = 0.941). CONCLUSION Approximately 5% of patients who underwent LCP or RIMN fixation developed nonunion. Therefore, LCP and RIMN are effective DFF techniques and mastering one of them is essential.
Collapse
Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - In Keun Park
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, South Korea
| | - Youngwoo Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyoung-Keun Oh
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Suk Kyu Choo
- Department of Orthopedic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea
| | - Yerl-Bo Sung
- Department of Orthopaedic Surgery, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, South Korea.
| |
Collapse
|