Early complications and reoperation rates are similar amongst open reduction internal fixation, intramedullary nail, and distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis

Quinzi, David A; Ramirez, Gabriel A.; Kaplan, Nathan; Myers, Thomas G.; Thirukumaran, Caroline; Ricciardi, Benjamin F.

doi:10.1007/s00402-021-03866-4

Cited by 33 publications

(40 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Knee range of motion was similar between the two groups, but other functional outcomes could not be investigated. Although periprosthetic fractures are not the focus of our study, a systematic review by Quinzi et al 24 had similar findings with no difference in overall complication or reoperation rates between dfA, orif, and imn.…”

Section: Discussionsupporting

confidence: 73%

Distal femoral arthroplasty for native knee fractures

Aebischer

Hau

Steiger

et al. 2022

The Bone & Joint Journal

View full text Add to dashboard Cite

Aims The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). Methods Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined. Results The AOANJRR identified 153 primary DFAs performed for native knee fractures in 151 patients during the study period, with 63.3% of these (n = 97) performed within the last five years. The median follow-up was 2.1 years (interquartile range 0.8 to 4.4). The patient population was 84.8% female (n = 128), with a mean age of 76.1 years (SD 11.9). The cumulative percent revision rate at three years was 10%. The most common reason for revision was loosening, followed by infection. Patient survival at one year was 87.5%, decreasing to 72.8% at three years postoperatively. Conclusion The use of DFA to treat native knee fractures is increasing, with 63.3% of cases performed within the last five years. While long-term data are not available, the results of this study suggest that DFA may be a reasonable option for elderly patients with native knee fractures where fixation is not feasible, or for whom prolonged non-weightbearing may be detrimental. Cite this article: Bone Joint J 2022;104-B(7):894–901.

show abstract

Section: Discussionsupporting

confidence: 73%

Distal femoral arthroplasty for native knee fractures

Aebischer

Hau

Steiger

et al. 2022

The Bone & Joint Journal

View full text Add to dashboard Cite

show abstract

“…We defined inclusion criteria following previous meta-analyses (Shah et al, 2020;Quinzi et al, 2021;Wadhwa et al, 2021): 1) patients were confirmed with PPDFF based on recognized criteria, 2) comparison of at least two of ORIF with periarticular locked plates, retrograde IMN, and DFR was available, 3) reported at least one of the data on major complications and revision rate, 4) randomized controlled trials (RCTs), or retrospective or prospective study designs, and 5) full text published in English.…”

Section: Eligibility Criteriamentioning

confidence: 99%

“…In contrast, surgical management was identified as the preferred therapeutic option (Su et al, 2004;Kinney and Engh, 2018). Although several surgical approaches have been widely used for treating PPDFF (Darrith et al, 2020), advancements in implant technology have greatly increased the focus on three primary surgical strategies, including open reduction internal fixation (ORIF) with periarticular locking plates, or intramedullary nail fixation (IMN), and distal femoral replacement (DFR) (Quinzi et al, 2021). Currently, several pairwise meta-analyses (Ebraheim et al, 2015;Shin et al, 2017;Liu et al, 2019;Shah et al, 2020) have compared the clinical efficacy and safety of these three surgical strategies; however, a definitive conclusion about which one should be preferentially selected for the treatment of PPDFF remains unclear.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Network Meta-Analysis of Open Reduction Internal Fixation, Intramedullary Nail Fixation, and Distal Femoral Replacement for Periprosthetic Distal Femur Fractures

Ren

et al. 2022

Front. Mater.

View full text Add to dashboard Cite

Background: Although open reduction internal fixation (ORIF) with periarticular locking plates, retrograde intramedullary nail (IMN) fixation, and distal femoral replacement (DFR) have been widely used for the treatment of periprosthetic distal femur fractures (PPDFF), it remains unclear which one may be an optimal surgical strategy.Objective: This network meta-analysis aimed to determine the optimal surgical strategy for PPDFF from ORIF, IMN, and DFR by evaluating major complication rates and revision rates.Patients and Methods: We identified eligible studies by performing an updated literature search in PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) and checking published meta-analyses. The methodological index for non-randomized studies (MINORS) was used to assess the methodological quality of eligible studies. Major complications and revision rates were defined as outcomes of interest. All statistical analyses were performed by ADDIS 1.4 software.Results: We included 17 eligible studies in the final analysis. Statistical analyses did not reveal significant differences when ORIF was compared with IMN and ORIF compared with DFR, and IMN compared with DFR in terms of two clinical outcomes. However, DFR achieved a beneficial trend in major complications [odds ratio (OR) = 1.34; 95% CrI = 0.48–3.80] and revision (OR = 1.64; 95% CrI = 0.68–4.38) rates compared with IMN. Ranking probabilities indicate that DFR has the highest probability of being the optimal option, followed by ORIF and IMN.Conclusion: There was no difference in major complications or reoperations between the three treatments. However, ORIF with periarticular locking plates may be a preferred alternative option because DFR is limited by the high cost. Moreover, our study highlights the need for future prospective trials evaluating the outcomes of these three surgical strategies.

show abstract

“…Open reduction and internal xation (ORIF) is the most common treatment of fractures [5,6]. Studies have demonstrated that compared with conservative treatment, ORIF showed a lower rate of nonunion with an increased patient satisfaction [7][8][9]. A study has shown that non-surgical treatment of the same type of fracture leads to an increased nonunion rate by 30%, while the nonunion rate is reduced to 6% with surgical treatment [10].…”

Section: Introductionmentioning

confidence: 99%

Medical Factors Associated With Fracture Nonunion: A Retrospective Study

Wang

Chen

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Nonunion is one of the medical conditions challenging the trauma specialists. Timely identification of people at high risk of nonunion is important to improve the prognosis of patients.Methods: We retrospectively analyzed the demographic and laboratory hematological characteristics of 338 patients with either clavicle or femoral fractures treated with ORIF in Shandong Provincial Hospital affiliated to Shandong University from January 2010 to May 2019. Descriptive statistics, univariate regression analysis, and multivariate regression analysis were conducted to confirm the independent factors associated with nonunion after ORIF.Results: The overall nonunion rate among the patients investigated in this study was ~6.8%, while the nonunion rates were 5.6% and 10.3% in clavicle and the femur fractures, respectively. Results of the univariate logistic regression analysis showed that the serum fibrinogen concentration (FIB), the hemoglobin count (HGB), the lymphocyte absolute value (LYMPH), the coefficient of variation of red blood cell distribution width (RDW-CV), the American Society of Anesthesiologists (ASA) classification, and the mechanism of injury were related to the occurrence of nonunion (p < 0.05). Results of the multivariate regression analysis showed that FIB (OR = 1.64, 95% CI of 1.14 to 2.36, p < 0.01), LYMPH (OR = 0.34, 95% CI of 0.15 to 0.77, p < 0.01), ASA classification (OR = 3.52, 95% CI of 1.20 to 10.31, p = 0.02), and injury mechanism (OR=3.13, 95% CI of 1.20 to 8.21, p = 0.02) were independently associated with the occurrence of nonunion.Conclusions: Our study has revealed that FIB, LYMPH, ASA classification, and injury mechanism are independently related to the occurrence of nonunion after ORIF, providing important guidance for clinicians to identify patients with high risk of nonunion in time, ultimately improving the prognosis and quality of life of patients.

show abstract

Early complications and reoperation rates are similar amongst open reduction internal fixation, intramedullary nail, and distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis

Cited by 33 publications

References 39 publications

Distal femoral arthroplasty for native knee fractures

Distal femoral arthroplasty for native knee fractures

Network Meta-Analysis of Open Reduction Internal Fixation, Intramedullary Nail Fixation, and Distal Femoral Replacement for Periprosthetic Distal Femur Fractures

Medical Factors Associated With Fracture Nonunion: A Retrospective Study

Contact Info

Product

Resources

About