Fractures of the Distal Femur

Leggon, Robert E.; Feldmann, Daniel D.; Lindsey, Ronald W.

doi:10.1007/978-3-642-87202-0_19

Cited by 6 publications

(8 citation statements)

References 47 publications

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“…Fracture of the distal femur is relatively uncommon in traumatic orthopaedics, accounting for 4.0% to 8.7% of all femoral fractures and less than 1% of all fractures in adults. 1,2 However, about 50% of the distal femur fractures involved the articular surface 1 , and if not well managed, they would impose a catastrophic consequence on the function of the knee. The gold standard of treatment of these intra-articular fractures was open reduction and internal fixation (ORIF) by metal plates and screws.…”

mentioning

confidence: 99%

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra‐articular fractures of distal femur: A multicentre study

Zhang²,

Cheng

et al. 2018

International Wound Journal

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There remains a lack of data on the epidemiological characteristics of surgical site infection (SSI) following the open reduction and internal fixation (ORIF) of intra‐articular fractures of distal femur, and the aim of this study was to solve this key clinical issue. The electronic medical records (EMRs) of patients who underwent ORIF for distal femoral fracture from January 2013 to December 2017 were reviewed to identify those who developed a SSI. Then, we conducted univariate Chi‐square analyses and used a multivariate logistic regression analysis model to determine the adjusted risk factors associated with SSI. A total of 724 patients who underwent ORIF of intra‐articular fractures of the distal femur were studied retrospectively, and 29 patients had postoperative SSIs. The overall incidence of SSIs was 4.0% (29/724), with deep SSIs being 1.5% (11/724), and superficial SSIs being 2.5% (18/724). Staphylococcus aureus was the most common causative pathogen (8, 42.1%), followed by mixed bacterial pathogens (5, 26.3%). Open fracture, obesity, smoking, and diabetes mellitus were identified as the adjusted risk factors associated with SSIs. Although modification of these risk factors may be difficult, patients and families should be counselled regarding their increased risk of SSI because these patients potentially benefit from focused perioperative medical optimisation.

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confidence: 99%

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra‐articular fractures of distal femur: A multicentre study

Zhang²,

Cheng

et al. 2018

International Wound Journal

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“…Deviation of the entry point from the “ideal” site could lead to varus/valgus or flexion/extension mal-reduction of the fibula fracture as the fibula rod fits into the proximal fibula canal. Suboptimal entry site and the resultant fracture mal-alignment was observed in nail fixation of other similar metaphyseal fractures, including proximal femur, 15 distal femur, 16 and proximal tibia. 17…”

Section: Discussionmentioning

confidence: 92%

“…Deviation of the entry point from the "ideal" site could lead to varus/valgus or flexion/ extension mal-reduction of the fibula fracture as the fibula rod fits into the proximal fibula canal. Suboptimal entry site and the resultant fracture mal-alignment was observed in nail fixation of other similar metaphyseal fractures, including proximal femur, 15 distal femur, 16 and proximal tibia. 17 Our study also found that around one third of the patients had a close distance of less than 2 mm from the rod to the outer cortex when the 3.6 × 180 mm rod is fitted inside the fibula shaft intramedullary canal, with one case breaching the posterolateral cortex.…”

Section: Discussionmentioning

confidence: 92%

Defining the fit and ideal entry site of the fibula rod system––a computed tomography based study in elderly patients with lower limb infections, vascular diseases or tumors

Cheung

Yee

Fang

2023

J Orthop Surg (Hong Kong)

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Objectives To determine the configuration of the distal fibula anatomy and the fitness of the Fibula Rod System (Acumed®, Hillsboro, Oregon) in a series of fibula models and to determine the optimal entry site of the rod. Methods Consecutive series of computed tomography (CT) of tibias and fibulae with no fracture or deformity were converted to stereo-lithograph format, and imported into Meshmixer software (Autodesk, San Rafael, California). A 3.6 × 180 mm fibula rod model was virtually inserted to best fit the intramedullary canal of the fibula model and to a depth of 0 mm proud at the distal fibula. The location of the entry point in relationship to the fibular tip, and the distance between the rod and the lateral fibula cortex were measured. Results CT of 41 fibulae (23 male and 18 female patients) contributed to the three-dimensional fibula modeling. The entry point was 3.5 mm (SD 2.0) medial to (in mortise view) and 1.0 mm (SD 2.1) anterior to (in lateral view) the fibular tip. The fibula rod was inserted to a depth of 6.2 mm (SD 2.1) proximal to the fibula tip. The mean shortest distance of the rod to the outer cortex was 1.88 mm (SD 0.87). There was a breach of the posterolateral cortex in one patient. Conclusion The guide pin entry site of fibula rod should be medial and anterior offset with reference to the fibula tip, in contrary to the distal tip as recommended in the manual. There is a chance of breaching the posterolateral cortex with rod entry.

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“…Although numerous studies have assessed risk factors associatied with SSI following traumatic orthopedic surgeries, very few of them focued on distal femur fractures. A major reason for this is the rarity of this type of fracture, which accounts for only 4.0% of all femoral fractures [14,15] and <1% of fractures in adults. [14] Even so, we should not neglect these injuries, because over 50% of them involved the articular surface [14] and if not well-managed, they would have a destructive consequence on the function of the knee.…”

Section: Introductionmentioning

confidence: 99%

“…The gold standard of treatment of distal femur fractures is open reduction and internal fixation (ORIF) by metal plates and screws. However, patients who undergo this surgery will have a relatively high rate of SSIs, [15,16] most likely due to the soft-tissue damage upon the accident, fracture severity, systematic comorbidities, tissue dissection during operation, wound contamination, and other patient- or surgery-related factors. In the latter study, Hoffmann et al [16] evaluated 106 patients who underwent locked plating for treatment of distal femoral fractures, and found 9 SSIs, including 8 deep infections and 1 superficial infection; they also identified open injury and current smoking as the associated risk factors.…”

Section: Introductionmentioning

confidence: 99%

Incidence of surgical-site infection following open reduction and internal fixation of a distal femur fracture

et al. 2019

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Surgical-site infection (SSI) is a common complication in orthopedic surgery; however, SSI after surgically managed distal femur fractures was not well studied. The aim of this study was to investigate the incidence of SSI and identify some modifiable and nonmodifiable risk factors. The patients’ electronic medical records (EMRs) were reviewed to identify those who sustained a distal femur fracture and treated by open reduction and internal fixation (ORIF) between March 2014 and February 2018. SSI was defined based on the Centers for Disease Control criteria and confirmed according to the descriptions in EMR. Univariate and multivariate logistic regression models were used to determine the independent risk factors associated with SSI. Totally, EMRs of 665 patients who underwent ORIF of distal femur fractures were reviewed and 24 SSIs were found, indicating the overall incidence of SSI was 3.6%. The rate of deep SSI was 1.2% and superficial SSI was 2.4%. Staphylococcus aureus was the most common causative pathogen, either alone (7/15, 46.7%) or as a mixed infection (3/15, 20%), followed by mixed bacterial (4/15, 26.7%) and S epidermidis (2/15, 13.3%) and others. Patients with SSI had approximately twice the length of hospital stay as those without SSIs (29.0 vs 16.0 days, P < .001). Open fracture, temporary use of external fixation, obesity, smoking, diabetes mellitus, and preoperative reduced albumin level were identified as independent risk factors associated with SSI, and current smoking and preoperative reduced albumin level were the true modifiable factors. Patients should be encouraged to cease smoking as early as possible and increase the good-quality protein intake to reduce or prevent the occurrence of SSI. An explanation of the nonmodifiable risk factors should be included when patients are counseled about their increased risk of SSI.

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Fractures of the Distal Femur

Cited by 6 publications

References 47 publications

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra‐articular fractures of distal femur: A multicentre study

Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra‐articular fractures of distal femur: A multicentre study

Defining the fit and ideal entry site of the fibula rod system––a computed tomography based study in elderly patients with lower limb infections, vascular diseases or tumors

Incidence of surgical-site infection following open reduction and internal fixation of a distal femur fracture

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