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Stadnyk M, Gibbon S, Buckley R. Are dual, lateral and medial plates, better than a single lateral locking plate for osteoporotic intra-articular distal femur fractures? Injury 2024; 55:111592. [PMID: 38733706 DOI: 10.1016/j.injury.2024.111592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Meredith Stadnyk
- University of Calgary, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, Canada T2N 5A1
| | - Stephanie Gibbon
- University of Calgary, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, Canada T2N 5A1
| | - Richard Buckley
- University of Calgary, 0490 McCaig Tower, Foothills Hospital, 3134 Hospital Drive NW Calgary, Alberta, Canada T2N 5A1.
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2
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Tian Z, Wei Z, Wang J, Meng C. Letter to the Editor: Geriatric distal femoral fractures: post‑operative complications and nine‑year mortality-a retrospective analysis of two tertiary trauma centres. INTERNATIONAL ORTHOPAEDICS 2024; 48:1123-1124. [PMID: 38302597 DOI: 10.1007/s00264-024-06101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Zhikang Tian
- Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Zichun Wei
- Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Jiahui Wang
- Jining Medical University, 133 Hehua Rd, Jining, 272067, China
| | - Chunyang Meng
- Affiliated Hospital of Jining Medical University, 89 Guhuai Rd, Jining, 272007, China.
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Chuluunbaatar Y, Benachar N, Khroud-Dhillon H, Srinivasan A, Rojoa D, Raheman F. Early and 1-year mortality of native geriatric distal femur fractures: A systematic review and time-to-event meta-analysis. J Clin Orthop Trauma 2024; 50:102375. [PMID: 38495682 PMCID: PMC10943051 DOI: 10.1016/j.jcot.2024.102375] [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: 09/13/2023] [Revised: 12/27/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Purpose Distal femur fractures (DFF) account for 6% of all femoral fractures and predominate in females. The current 1-year mortality of DFF is currently reported to be between 10 and 38%, a wide margin, and confounded by multiple factors including age, high energy mechanisms, pathological and periprosthetic fractures. The purpose of this study was to assess and determine all-cause mortality following geriatric native distal femur fractures at 30 days, six months and one year. Methods - The databases Cochrane CENTRAL, MEDLINE, EMBASE and NHS NICE Healthcare Databases Advanced Search Interface were searched in accordance with PRISMA guidelines. Original research articles relevant to mortality outcomes in native geriatric distal femur fractures following low energy trauma were included. A time-to-event data meta-analysis model was used to estimate pooled 30-day, six month and one-year mortality. A random effects meta-regression model was performed to assess potential sources of heterogeneity when studies reported on factors affecting the mortality observed in patients with geriatric distal femur fractures. Results - Thirteen studies were included in the meta-analysis with a mean age of 79.6 years. Eight studies reported the 30-day mortality of distal femur fractures in patients as a pooled estimate of 8.14%. Pooled estimate for 6-month mortality reported was 19.5% and the one-year mortality reported by ten studies was 26.10%. Time-to-event modelling showed that risk of mortality at one year in elderly patients with distal femur fractures was significantly higher HR = 4.31 (p < 0.001). When evaluating prognostic predictors, age and Type C fracture were predictive of highest mortality rates. Conclusions - This study is the first meta-analysis to evaluate the early and long-term mortality observed in elderly patients presenting with native distal femoral fractures. Through our results we have shown the quantifiable impact patient age and fracture configuration has on one-year mortality in this patient cohort.
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Affiliation(s)
- Yanjinlkham Chuluunbaatar
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | - Nawal Benachar
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | - Harnoor Khroud-Dhillon
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
| | | | - Djamila Rojoa
- Leicester Royal Infirmary, Leicester, LE1 5WW, United Kingdom
| | - Firas Raheman
- Department of Orthopaedics, Lister Hospital, East and North Hertfordshire Trust, Corey Mill Lane, Stevenage, SG1 4AB , United Kingdom
- Royal Free London NHS Trust, London, NW3 2QG, United Kingdom
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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.
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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
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5
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Braun BJ, Hofmann K, Rollmann MF, Menger MM, Ahrend MD, Ihle C, Histing T, Herath SC. Weight-bearing Restrictions after Distal Femur Fractures - Review of Current Literature. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023; 161:610-618. [PMID: 35315006 DOI: 10.1055/a-1766-7781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The incidence of distal femur fractures increases in the geriatric patient. The primary treatment goal in these fractures is early mobilisation to prevent secondary injuries associated with immobility. In light of the increasing spectrum of therapeutic options for postoperative fracture treatment, including double plating, nail-plate combination and distal femur replacement as postoperative treatments, weight-bearing recommendations are becoming increasingly important. The aim of this study was thus to analyse the weight-bearing recommendations and associated therapy results within the literature of the past 9 years and compare the recommendations to our own approach.
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Affiliation(s)
- Benedikt J Braun
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Kira Hofmann
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Mika Fr Rollmann
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Maximilian M Menger
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Marc-Daniel Ahrend
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Christoph Ihle
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Tina Histing
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Steven C Herath
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinik Tübingen, Tübingen, Deutschland
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Onizuka N, Farmer S, Wiseman JM, Alain G, Quatman-Yates CC, Quatman CE. Timing of Complications Following Surgery for Distal Femur Fractures in Older Adults. Geriatr Orthop Surg Rehabil 2023; 14:21514593231195539. [PMID: 37600451 PMCID: PMC10434182 DOI: 10.1177/21514593231195539] [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: 08/22/2023] Open
Abstract
Introduction The purpose of this study was to identify the timing and nature of complications associated with distal femur fracture surgery in patients aged 65 and older using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Methods The ACS NSQIP database was queried for adults aged 65 and older who received surgical treatment for a distal femur fracture between 01 January 2015 and 31 December 2021. Cox regression models and risk tables adjusted for baseline clinical characteristics were created for 14 complications (Superficial Surgical Site Infection (SSI), Deep SSI, Organ/Space SSI, Pneumonia, Pulmonary Embolism (PE), Deep Venous Thrombosis (DVT), Urinary Tract Infection (UTI), Stroke/Cerebrovascular accident (CVA), Myocardial Infarction (MI), Renal Failure, Cardiac Arrest (CA), Re-operation, Sepsis, and Death within 30 days of surgery). Model summaries were used to identify significant variables with a Bonferroni correction applied. Results A total of 3956 adults met inclusion criteria and were included in analysis. The most common complications were UTI (5.2%), death (4.1%), and pneumonia (3.4%). Complications typically occurred within 14 days after surgery, except for SSI, which occurred between post-op days 11 and 24. Conclusions Distal femur fractures are a substantial source of morbidity and mortality in the older adult population. Our findings underscore the need for comprehensive preoperative risk assessment and patient management strategies to mitigate the impact of identified risk factors in this vulnerable population.
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Affiliation(s)
- Naoko Onizuka
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
- Park Nicollet Methodist Hospital, Saint Louis Park, MN, USA
| | - Samuel Farmer
- Division of Trauma, Department of Orthopaedics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jessica M Wiseman
- Division of Trauma, Department of Orthopaedics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Gabriel Alain
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Catherine C Quatman-Yates
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Sports Medicine Research Institute, Chronic Brain Injury Program, The Ohio State University, Columbus, OH, USA
| | - Carmen E Quatman
- Division of Trauma, Department of Orthopaedics, College of Medicine, The Ohio State University, Columbus, OH, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
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Sainio H, Rämö L, Reito A, Silvasti-Lundell M, Lindahl J. Prediction of fracture nonunion leading to secondary surgery in patients with distal femur fractures. Bone Jt Open 2023; 4:584-593. [PMID: 37580052 PMCID: PMC10425244 DOI: 10.1302/2633-1462.48.bjo-2023-0077.r1] [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] [Indexed: 08/16/2023] Open
Abstract
Aims Several previously identified patient-, injury-, and treatment-related factors are associated with the development of nonunion in distal femur fractures. However, the predictive value of these factors is not well defined. We aimed to assess the predictive ability of previously identified risk factors in the development of nonunion leading to secondary surgery in distal femur fractures. Methods We conducted a retrospective cohort study of adult patients with traumatic distal femur fracture treated with lateral locking plate between 2009 and 2018. The patients who underwent secondary surgery due to fracture healing problem or plate failure were considered having nonunion. Background knowledge of risk factors of distal femur fracture nonunion based on previous literature was used to form an initial set of variables. A logistic regression model was used with previously identified patient- and injury-related variables (age, sex, BMI, diabetes, smoking, periprosthetic fracture, open fracture, trauma energy, fracture zone length, fracture comminution, medial side comminution) in the first analysis and with treatment-related variables (different surgeon-controlled factors, e.g. plate length, screw placement, and proximal fixation) in the second analysis to predict the nonunion leading to secondary surgery in distal femur fractures. Results We were able to include 299 fractures in 291 patients. Altogether, 31/299 fractures (10%) developed nonunion. In the first analysis, pseudo-R2 was 0.27 and area under the receiver operating characteristic curve (AUC) was 0.81. BMI was the most important variable in the prediction. In the second analysis, pseudo-R2 was 0.06 and AUC was 0.67. Plate length was the most important variable in the prediction. Conclusion The model including patient- and injury-related factors had moderate fit and predictive ability in the prediction of distal femur fracture nonunion leading to secondary surgery. BMI was the most important variable in prediction of nonunion. Surgeon-controlled factors had a minor role in prediction of nonunion.
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Affiliation(s)
- Heini Sainio
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aleksi Reito
- Centre for Musculoskeletal Diseases, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marja Silvasti-Lundell
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jan Lindahl
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Elabd MA, Mahmoud AN, Elzaher EH, Kamel ME. Early ambulation and good outcomes after using combined nail plate construct for fixation of distal femoral fractures: a retrospective series of 14 cases. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2023; 13:166-172. [PMID: 37736028 PMCID: PMC10509538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 07/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Combined nail/plate technique is a relatively novel method for surgically managing distal femur fractures. It was supposed to allow for early weight bearing and achieve adequate fixation that allow for good bone healing. This study aims to describe our single institution experience of treating distal femur fractures using the combined nail/plate technique. METHODOLOGY This is a retrospective study of 14 cases who had AO/OTA fractures 33A_C that were managed with this technique. Patients mean age was 67.6 years and all of them had either obvious osteopenia/osteoporosis or comminuted fractures. RESULTS With early postoperative weight bearing, after a mean follow up of 13.2 months, all the patients were able to return to preinjury activity level. None of the cases were revised for union related problems. Adequate bone healing was noticed after a mean of 16.8 weeks postoperatively. At the final follow up, the mean Oxford knee score was 42 (range 34-46). CONCLUSION The combined nail/plate technique provides adequate fixation method that allows for early weight bearing and good functional outcomes. More studies, ideally comparative are needed to properly assess the cost benefit of this technique compared to other techniques.
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Affiliation(s)
- Mostafa Aly Elabd
- Department of Orthopedic Surgery, Ain Shams University Faculty of Medicine and University Hospitals Cairo, Egypt
| | - Ahmed Nageeb Mahmoud
- Department of Orthopedic Surgery, Ain Shams University Faculty of Medicine and University Hospitals Cairo, Egypt
| | - Elzaher Hassan Elzaher
- Department of Orthopedic Surgery, Ain Shams University Faculty of Medicine and University Hospitals Cairo, Egypt
| | - Muhammad Elsayed Kamel
- Department of Orthopedic Surgery, Ain Shams University Faculty of Medicine and University Hospitals Cairo, Egypt
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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: 1] [Impact Index Per Article: 0.5] [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.
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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
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Practical approach to the native distal femur fractures in the elderly: A rapid review over the recent trends. Injury 2022; 53:2389-2394. [PMID: 35644641 DOI: 10.1016/j.injury.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
Significant work has been done in recent years on treatment strategies for distal femur fractures. Inclusive reviews on periprosthetic fractures of distal femur have been carried out recently, but there is a lack of such reviews on the subject of native distal femur fractures in the recent literature. In this narrative review, we are set out to address the latest updates on geriatric non-periprosthetic distal femur fractures, and perform a rapid review over different treatment options, arriving at a summarized proposed treatment algorithm.
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Zanchini F, Piscopo A, Cipolloni V, Fusini F, Cacciapuoti S, Piscopo D, Pripp C, Nasto LA, Pola E. Distal femur complex fractures in elderly patients treated with megaprosthesis: Results in a case series of 11 patients. World J Orthop 2022; 13:454-464. [PMID: 35633750 PMCID: PMC9124994 DOI: 10.5312/wjo.v13.i5.454] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/19/2022] [Accepted: 04/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial. Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques. Recently, several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures. AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85. METHODS Data from 11 consecutive patients (10 females, 1 male) presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded. We collected standard demographic data, comorbidities and patient reported outcomes including Visual Analogical Scale (VAS), Oxford Knee Score (OKS) and Barthel's Index. Post-operative joint range of motion (ROM) and standard radiographic data were also collected. RESULTS At a mean follow-up of 23.2 mo, all of the implants were well-positioned and osteointegrated. Furthermore, all the patients were alive and walking either independently or with walking aids. There was a marked improvement in pain (VAS 4.5 postop vs 1.9 at the last follow-up), OKS score (29.5 postop vs 36.81 at the last follow-up), ROM (96.2° postop vs 102° at the last follow-up) and restoration of pre-injury ambulatory status (average Barthel Index 77.3). The radiographic evaluations showed good restoration of the articular geometry. No deaths and no complications were recorded. CONCLUSION In conclusion, we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice. This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis. It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.
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Affiliation(s)
- Fabio Zanchini
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Antonio Piscopo
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Valerio Cipolloni
- Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli IRCCS University Hospital, Catholic University of Rome, Rome 00168, Italy
| | - Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Mondovì 12084, Italy
| | - Stefano Cacciapuoti
- Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
| | - Davide Piscopo
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Charlotte Pripp
- Service de Geriatrie et réaaptation HUG, Hôpital de Bellerive Chem, Genève 1205, Switzerland
| | - Luigi Aurelio Nasto
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
| | - Enrico Pola
- Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
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12
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Primary fibular grafting combined with double plating in distal femur fractures in elderly patients. INTERNATIONAL ORTHOPAEDICS 2022; 46:2145-2152. [PMID: 35579697 PMCID: PMC9371996 DOI: 10.1007/s00264-022-05441-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/10/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE To report functional and radiological outcomes of using primary fibular graft together with double plating in distal femoral fractures in the elderly. METHODS A retrospective study on 30 elderly patients with comminuted distal femoral fractures managed by primary fibular grafting and double plating through an anterior midline approach has been conducted. Only isolated distal femoral fractures type 33-A3, 33-C2, and 33-C3 were included. The patient's mean age was 75.3 years. Evaluation included operative time, blood loss, time to union, knee range of motion, Sanders scoring, and presence of complications. RESULTS The average follow-up period was 26.6 months. Mean intraoperative blood loss was 401 ml, and mean operative time was 216 min. All patients had a knee range of motion (90-120°) during follow-up. Time for union ranged from 16 to 23 weeks with a mean of 18.4 weeks, with no cases of non-union. A total of 22 patients (73.3%) showed excellent functional outcomes, and the remaining eight (26.7%) showed good functional outcomes according to the Sanders scoring system. Only two cases (6.6%) had superficial wound infections managed conservatively. No post-operative deformity, loss of reduction, or implant failure was observed until the end of follow-up period. CONCLUSION Primary fibular grafting combined with double plating of comminuted distal femur fractures in patients above 70 years is an effective technique with higher rates of union and lower re-operation rates compared to other fixation modalities.
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Joshi N, Pujol O, Prat S. Complex distal femoral fractures in the fragile elderly patient treated by distal femoral replacement: A report of three cases. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:149-153. [DOI: 10.1016/j.recot.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/22/2021] [Accepted: 07/18/2021] [Indexed: 10/19/2022] Open
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Joshi N, Pujol O, Prat S. [Artículo traducido] Fractura de fémur distal compleja en el paciente frágil y anciano tratada mediante reemplazo femoral distal: reporte de 3 casos. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T149-T153. [DOI: 10.1016/j.recot.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 07/18/2021] [Indexed: 10/19/2022] Open
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15
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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.
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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
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Garala K, Ramoutar D, Li J, Syed F, Arastu M, Ward J, Patil S. Distal femoral fractures: A comparison between single lateral plate fixation and a combined femoral nail and plate fixation. Injury 2022; 53:634-639. [PMID: 34836629 DOI: 10.1016/j.injury.2021.11.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/07/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Distal femoral fractures occur in patients with osteoporotic bone and also as a consequence of high energy trauma. The recognised treatment options include closed or open reduction of the fracture and fixation using a locking plate or a femoral nail. Both these fixation modalities have some drawbacks. There is a risk of metalwork failure with single lateral locking plates and limited distal fixation with intramedullary nails. Since January 2018, we started using augmented fixation of distal femoral fractures using a combination of a retrograde femoral nail and a lateral locking plate. This study compares the outcomes of single lateral femoral plating (SLP) and combined nail-plate fixation (NPF). METHODS This is a single centre retrospective case control study including all patients who sustained distal femoral fractures (OTA 33-A2, 33-A3, 33-C, 33-V3B and 33-V3D) over the study period. Outcomes for SLP were compared to NPF. The principal outcome measure was fracture union. Secondary outcome measures were reoperation rate, mortality and post-operative weight bearing status. RESULTS 67 distal femoral fractures were included in the study. 19 patients had peri‑prosthetic fractures. 40 were treated by SLP, 27 were managed with NPF. 23 (58%) patients in the SLP group were given instructions to non-weight bear or Toe touch weight bear for 6 weeks post-surgery compared to 1 (4%) in the NPF group (p = 0.000004). 7 (18%) patients treated with SLP had metalwork failure due to a non-union compared to none treated with NPF (p = 0.04). 11 fractures in the SLP group failed to unite compared to no non-unions in the NPF group (p = 0.01). These differences were magnified when assessing older (>50 years old) patients. CONCLUSIONS Augmented fixation of distal femoral fractures using a nail plate fixation provided significantly higher union and enabled early weightbearing compared to single plate fixation. We recommend nail plate fixation for the treatment of distal femoral fractures, particularly in osteoporotic fractures.
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Affiliation(s)
- Kanai Garala
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry. CV2 2DX, United Kingdom.
| | - Darryl Ramoutar
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry. CV2 2DX, United Kingdom.
| | - James Li
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry. CV2 2DX, United Kingdom.
| | - Farhan Syed
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry. CV2 2DX, United Kingdom.
| | - Mateen Arastu
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry. CV2 2DX, United Kingdom.
| | - Jayne Ward
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry. CV2 2DX, United Kingdom.
| | - Sunit Patil
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry. CV2 2DX, United Kingdom.
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17
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Striano BM, Grisdela PT, Shapira S, Heng M. Early Weight Bearing after Distal Femur Fracture Fixation. Geriatr Orthop Surg Rehabil 2022; 13:21514593211070128. [PMID: 35111355 PMCID: PMC8801638 DOI: 10.1177/21514593211070128] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives To assess outcomes following early weight bearing after distal femur fracture fixation with locked lateral plating. Design Retrospective cohort study Setting Two Level 1 Academic Trauma Centers. Patients/Participants Patients 18 years and older with distal femur fractures treated with locked lateral plating Intervention Early full weight bearing (defined as less than 30 days from date of surgery) versus restricted post-operative weight bearing Main Outcome Measurements Composite complication comprising malunion, nonunion, surgical site infection, re-admission, or death Results 270 distal femur fractures were reviewed, with 165 meeting inclusion criteria. 21 patients had been allowed early full weight bearing. Fractures were divided into two groups based on when full weight bearing was allowed post-operatively. The two groups had similar fractures as determined by the distribution of AO distal femur fracture and Su periprosthetic femur fracture classifications. The early weight bearing group was significantly older and more comorbid. Despite being older, more comorbid, and allowed early full weight bearing on their fracture fixation construct, there was no difference in the rate of composite complications between groups. Conclusion Our data contributes to the small, but growing body of literature that has found no increased rate of fracture related complications in surgically treated distal femur fractures allowed early post-operative weight bearing. Level of Evidence Therapeutic Level III Study.
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Affiliation(s)
| | | | - Shay Shapira
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel
- Harvard Medical School Orthopaedic Trauma Initiative, Boston MA, USA
| | - Marilyn Heng
- Harvard Medical School Orthopaedic Trauma Initiative, Boston MA, USA
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
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18
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Outcomes of Primary Total Knee Arthroplasty in Fractures Around the Knee in the Elderly: A Systematic Review and Pooled Analysis of 212 Patients Across 11 Studies. Indian J Orthop 2021; 56:533-546. [PMID: 35342521 PMCID: PMC8921389 DOI: 10.1007/s43465-021-00579-z] [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: 09/03/2021] [Accepted: 11/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Treatment of fractures around the knee in the elderly is somewhat controversial with primary total knee arthroplasty (TKA) gaining prominence over the past decade or so, as an alternative for open reduction and internal fixation. The present review was conceptualized to review the published literature and evaluate outcomes of TKA in these patients, and to understand whether this is a viable treatment option for these fractures. We have further tried to identify complications and the challenges faced while performing this surgery. METHODS PRISMA guidelines were followed and search was conducted on three databases-PubMed, EMBASE and SCOPUS. Studies evaluating multiple factors related to outcomes and complications in primary TKA performed for fractures around the knee in the elderly were included. Cadaveric studies, conference abstracts, case reports, and any studies that included non-traumatic cases or revision after failed internal fixation, were all excluded. RESULTS Eleven studies, published between 2011 and 2021 were included in our review. There was significant female preponderance in the study population (M:F = 1:3). Implants with higher constraint (high post, hinged prosthesis) were frequently required to compensate for ligamentous laxity due to the fractures. On pooled analysis the mean Knee Society Score (KSS) knee score was 84.62 (excellent), and mean knee range of motion was 107.25°. However, the mean KSS function score was 56.71 (poor), which could have been due to co-morbid conditions and pre-operative status. Overall complication rate was 14.6%; surgical site infection was the most commonly reported. CONCLUSION There remains limited evidence for the use of TKA as a primary treatment option for these injuries. In the presence of specific conditions, and in expert hands-it may be a viable alternative to osteosynthesis with comparable outcomes. More focused studies are needed to compare the two treatment options and to formulate guidelines.
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Tsai SHL, Lin TY, Tischler EH, Hung KH, Chen CH, Osgood GM, Fu TS, Su CY. Distal femur fractures have a higher mortality rate compared to hip fractures among the elderly: Insights from the National Trauma Data Bank. Injury 2021; 52:1903-1907. [PMID: 33896612 DOI: 10.1016/j.injury.2021.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/27/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The comparison of mortality and morbidity between distal femur (DF) and hip fracture in the old age is rarely reported in the literature. We aim to analyze a nationwide database among the elderly to compare the outcomes between hip fractures and distal femur fractures in the United States. MATERIALS AND METHODS A retrospective analysis of the National Trauma Data Bank was queried between 2007-2014 to identify distal femur (DF) and hip fracture patients greater than 65 years of age. Outcomes analyzed included in-hospital mortality, total hospital length of stay(LOS), intensive care unit length of stay(ICU-LOS), length of ventilation use and hospital discharge disposition. Multivariable regression models were performed to adjust for potential confounders. Statistical significance was established at p < 0.001. RESULTS 26,325 (10.1%) and 233,213 (89.9%) patients reported a diagnosis of DF and hip fracture, respectively. The inpatient mortality rate was significantly higher in the distal femur fracture group (8.3% vs. 6.7%), with significantly longer LOS (7.87 vs. 6.65), ICU-LOS (1.50 vs. 0.73), and required ventilation days (0.74 vs. 0.27). Multivariable analyses demonstrated that hip fracture patients had a lower mortality (adjusted odds ratio [aOR], 0.80; 95% CI [0.76, -0.85]; p < 0.001), shorter LOS ([aOR], -0.31; 95% CI [-0.39, -0.23]; P < 0.001), and more likely to be discharged home ([aOR], 0.88; 95% CI, 0.85, 0.91; P < 0.001, compared to DF fracture patients. CONCLUSION After adjusting for potential factors, DF fracture patients have a significantly higher mortality, longer LOS, and less likely to be discharged home compared to hip fractures among the elderly. These results may suggest clinicians and caregivers for closely monitoring of clinical conditions for these patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tung-Yi Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Eric H Tischler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, United States
| | - Kuo-Hsien Hung
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chien-Hao Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Greg Michael Osgood
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chun-Yi Su
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, and School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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20
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Hou N, Zhang H, Bai M, Chen H, Song W, Wang L. The Old Supracondylar Fracture of Femur Treated by Gradual Deformity Correction Using the Ilizarov Technique Followed by the Second-Stage Internal Fixation in an Elderly Patient With Osteoporosis. Geriatr Orthop Surg Rehabil 2020; 11:2151459320931673. [PMID: 32577319 PMCID: PMC7289063 DOI: 10.1177/2151459320931673] [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] [Received: 09/13/2019] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The supracondylar nonunion of femur in elderly individuals is rare and
challenging to manage. Nothing in English literatures or guidelines is
available regarding this particular fracture characterized by osteoporosis,
soft-tissue contracture, shortening, and joint stiffness. We report a case
of an elderly patient with a supracondylar nonunion of the femur, which was
successfully treated using staged Ilizarov techniques and dual plating. Case Presentation: An 84-year-old female patient was admitted to our orthopedic department for
her pain and soft-tissue swelling around the right knee with claudication
and shortening deformity of the affected extremity. She denied any specific
history of trauma and had sought traditional Chinese medical attention for 6
months before she presented to our hospital. Diagnosis of the right femoral
supracondylar nonunion was made based on the X-ray and computed tomography.
Ilizarov external fixator was carried out for successive and slow
distraction and gradual correction of the shortening deformity, in
consideration of the nonunion was still present. Subsequently, internal
fixation with dual plating of the distal femur was performed. Excellent
function and patient satisfaction were observed at 6 months of
follow-up. Conclusion: The protocol of Ilizarov technique with subsequent internal fixation of dual
plating seems to be an efficient solution to the supracondylar nonunion of
femur in elderly patients with osteoporosis. The advantage of the protocol
is that it allows knee joint motion, avoids neurovascular complications, and
gentle correction of soft-tissue contractures.
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Affiliation(s)
- Nianzong Hou
- Department of Orthopedic Surgery, Zibo Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Zibo, Shandong Province, China
| | - Haiyang Zhang
- Department of Orthopedic Surgery, Zibo Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Zibo, Shandong Province, China
| | - Mingjian Bai
- Department of Clinical Laboratory, Aerospace Central Hospital, Beijing, China
| | - Hao Chen
- Department of Orthopedic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Weidong Song
- Department of Orthopedic Surgery, Sun Yat-sen Memorial Hospital Affiliated to Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Liming Wang
- Department of Orthopedic Surgery, Zibo Central Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, Zibo, Shandong Province, China
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21
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Canton G, Giraldi G, Dussi M, Ratti C, Murena L. Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:25-32. [PMID: 31821280 PMCID: PMC7233703 DOI: 10.23750/abm.v90i12-s.8958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 11/23/2022]
Abstract
Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. They represent a relevant cause of morbidity and mortality in the geriatric population with a reported 1-year mortality reaching 30%. Non-displaced fractures or even displaced fractures in patients with high operative risk can be treated conservatively. However, operative treatment is the most widely accepted management option for displaced fractures. The advantage resides in early mobilization and weight-bearing, reducing risks related with a prolonged immobilization when compared with conservative treatment. On the other hand, the intrinsic difficulty of fixing an osteoporotic bone is a major concern. The presence of osteosynthesis devices or prosthetic implants in the femur can make the surgical treatment more challenging, sometimes limiting therapeutic options. Aim of the present paper is to review the most recent literature about osteoporotic distal femur fractures in the elderly, including periprosthetic and other hardware related fractures, to highlight current evidence on management options and related results as a guide for the daily clinical practice.
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Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy..
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