Interprosthetic femoral fractures managed with modern distal femoral locking plates: 10 years’ experience at a UK major trauma centre

Mittal, Aaina; Poole, W. E.; Crone, David

doi:10.1016/j.injury.2021.04.014

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…In the presence of an ipsilateral total hip, a short nail may be considered but carries a risk of interprosthetic fracture. 35 In these cases, a plate may be a better alternative to protect the whole femur, or this may be an indication to combine a plate and nail together. For fractures about a total knee, only specific primary knee femoral components are compatible with a nail.…”

Section: Nailing Plating or Both: Optimizing Stabilitymentioning

confidence: 99%

Distal femur fractures: basic science and international perspectives

Nauth,

Haller,

Augat

et al. 2024

OTA International

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Distal femur fractures are challenging injuries to manage, and complication rates remain high. This article summarizes the international and basic science perspectives regarding distal femoral fractures that were presented at the 2022 Orthopaedic Trauma Association Annual Meeting. We review a number of critical concepts that can be considered to optimize the treatment of these difficult fractures. These include biomechanical considerations for distal femur fixation constructs, emerging treatments to prevent post-traumatic arthritis, both systemic and local biologic treatments to optimize nonunion management, the relative advantages and disadvantages of plate versus nail versus dual-implant constructs, and finally important factors which determine outcomes. A robust understanding of these principles can significantly improve success rates and minimize complications in the treatment of these challenging injuries.

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Section: Nailing Plating or Both: Optimizing Stabilitymentioning

confidence: 99%

Distal femur fractures: basic science and international perspectives

Nauth,

Haller,

Augat

et al. 2024

OTA International

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“…The largest case series of IFFs treated with locked plating was reported by Mittal et al and included 49 closed IFFs treated over a 10-year period using MIPO with modern distal femoral locking plates 38 . The authors reported a union rate of 91% (31/34) of the patients available for follow-up.…”

Section: Minimally Invasive Plate Osteosynthesis (Mipo) Has Been Comp...mentioning

confidence: 99%

Interprosthetic Femur Fractures

McMellen

Romeo

2022

JBJS Reviews

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The prevalence of interprosthetic femur fractures (IFFs) is rising with the aging population and increased prevalence of total joint arthroplasty.» IFFs have high rates of complications and high associated morbidity and mortality.» The main treatment methods available for IFFs include plate fixation, intramedullary nailing, combined plate fixation and intramedullary nailing, and revision arthroplasty including partial and total femur replacement.» There have been several proposed classification systems and at least 1 proposed treatment algorithm for IFFs; however, there is no consensus.» Whichever treatment option is chosen, goals of surgery should include preservation of blood supply, restoration of length, alignment, rotation, and sufficient stabilization to allow for early mobilization. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A861).

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“…The two largest samples sizes included Sah et al who reported no cases of reported postoperative ambulatory changes, and Platzer et al who reported six cases of postoperative ambulatory status declines (Platzer et al 2011;Sah et al 2010). Two additional studies, Hoffman et al and Mittal et al, reported a total of 76 patients that returned to "weight-bearing as tolerated;" however, there was no mention of these patients requiring additional assistive devices postoperatively (Hoffmann, Lotzien, and Schildhauer 2016;Mittal, Poole, and Crone 2021).…”

Section: General Study Characteristicsmentioning

confidence: 99%

“…The last nonunion in their study was a patient that was plated with a working length of four holes and noted to be malreduced with the TKA component fixed in varus and extension. This patient underwent two re-operations due to nonunion with fracture of plates on each occasion at which point the patient underwent plate-retrograde intramedullary nail (IMN) fixation that achieved union at six months postoperatively (Mittal, Poole, and Crone 2021). Bonnevialle et al reported on four nonunions in their study and noted the likely reason for failure was due to a "short plate," which they defined as a plate length that did not bridge the femoral stem or reach the distal epiphysis.…”

Section: Malunion/nonunionmentioning

confidence: 99%

“…The majority of revisions were due to malunions or nonunions-analyzed above-followed by revision due to hardware failure (30%) and SSI (13%). Mittal et al reported on four revision operations: three for nonunion and one for secondary IFF above the plate after union had already occurred (Mittal, Poole, and Crone 2021). Two revisions were seen by Chakravarthy et al, which were both reported as "technical errors" during initial fixation of the IFFs-one less invasive stabilization system (LISS) plate failing at two weeks postoperatively and one implant failure with a new fracture seen at the distal-most screw of the locking compression plating (LCP), which was treated with a retrograde intramedullary nail (Chakravarthy, Bansal, and Cooper 2007).…”

Section: Journal Of Orthopaedic Experience and Innovationmentioning

confidence: 99%

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Interprosthetic Femur Fractures: Systematic Review

Golub,

Ng,

Vakharia

et al. 2022

Journal of Orthopaedic Experience &Amp; Innovation

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Objectives Interprosthetic femur fractures (IFF) present unique challenges to orthopaedic surgeons due to the preexisting implants in place, oftentimes advanced age and poor bone quality. Through the development of specific implants and improvement of fixation principles, management of this rare—yet growing—fracture pattern has progressed in recent decades to improve patient outcomes. This study’s aim was to identify patient-related outcomes after undergoing ORIF of interprosthetic femur fractures, including time to union, change in pre-operative ambulatory status, malunion/nonunion, surgical site infections, and revisions. Data sources A systematic review of published literature was conducted on Pubmed/MEDLINE and Cochrane Library databases for English language papers published with 12 studies meeting inclusion/exclusion criteria. Study selection Studies providing quantitative data comparing time to union, change in ambulatory status, surgical site infections, malunion/nonunion, revisions, and one-year mortality were used in the analysis. Studies lacking quantitative data were excluded. Data extraction 12 studies were included in this systematic review and graded by MINOR to identify potential biases. The aforementioned patient outcomes were calculated as mean values, ranges, and percentages. Data synthesis Time to union averaged 20.2 (range 6-28) weeks with roughly 18% of patients experiencing a decline in pre-operative ambulatory status. It was found 1.3% of patients experienced surgical site infections that were treated successfully either operatively or nonoperatively. Malunions and nonunions occurred in 1.63% and 6.12% of cases, respectively. Revisions were necessary in 12.6% of cases due to malunion, nonunion, and hardware failure. The one-year mortality rate was 12.8%. Conclusion Our review demonstrates that interprosthetic femur fractures continue to pose significant challenges in their treatment to both patients and orthopaedic surgeons. With the expected continued growth in the number of primary total hip and total knee arthroplasty performed annually, the incidence of interprosthetic femur fractures will continue to rise. Full femur spanning locked plating is currently the standard of care in fracture patterns with stable prostheses. Level of Evidence Therapeutic Level III

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Interprosthetic femoral fractures managed with modern distal femoral locking plates: 10 years’ experience at a UK major trauma centre

Cited by 5 publications

References 25 publications

Distal femur fractures: basic science and international perspectives

Distal femur fractures: basic science and international perspectives

Interprosthetic Femur Fractures

Interprosthetic Femur Fractures: Systematic Review

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