Abstract:Fractures of the distal femur remain a daunting challenge. Since 1970, operative treatment has been recommended. Unfortunately, it is fraught with complications, and techniques have been developed to limit incidence of non-union, infection and stiffness. A soft-tissue friendly approach is the key point, with minimally invasive surgery as the ultimate goal: its biological and anatomical advantages have been demonstrated, but clinical studies have been less convincing, being based on historical series. At presen… Show more
“…Distal femoral fractures are a challenging group of injuries for the orthopedic surgeon to treat [19]. This study has reflected what is already known in the literature regarding high rates of non-union, decreased post-operative functioning, and increased mortality.…”
Section: Discussionmentioning
confidence: 75%
“…In this setting, there may be a role for intramedullary fibular strut allograft use and or addition of a medial plate [38, 39]. Various aids to reduction in using MIPO technique, such as joystick pins, percutaneous clamps, and maximizing use of the plate as a reduction tool, have been described [19]. Further work is needed to determine an acceptable degree of reduction in application of MIPO technique, and whether the benefits of achieving anatomical reduction outweigh the invasiveness of the approach.Fig.…”
Background
The primary aim was to compare the outcomes of locked plating of closed distal femur periprosthetic and non-periprosthetic fractures by testing the hypothesis that outcomes would be worse in the periprosthetic group. The secondary aim of this study was to identify risk factors for non-union.
Methods
A single-center study over an 8-year period utilizing a retrospective cohort design was performed. Sixty-eight patients with periprosthetic fractures and 57 patients with non-periprosthetic fractures met inclusion criteria for the study. There was a significant difference between groups in mean age (80.1 years periprosthetic vs. 70.9 years non-periprosthetic (
p
< 0.001)). Statistical analysis between groups was used to assess the outcomes of time to union, incidence of non-union, post-operative functionality, incidence of complications, progression to revision surgery, and mortality. A secondary multivariable analysis was used to assess risk factors for non-union and factors positively associated with union.
Results
There were no significant differences in outcomes between groups. Union rates were 83.8% (57/68) in the periprosthetic group and 78.9% (45/57) in the non-periprosthetic group (
p
= 0.648). Comminution was identified as a significant risk factor for non-union (
p
= 0.005). Use of a submuscular technique had a significant positive association with union (
p
= 0.006).
Conclusions
Outcomes of surgical treatment for periprosthetic and non-periprosthetic distal femur fractures are similar. There is a significant risk of non-union in locked plating of both groups.
“…Distal femoral fractures are a challenging group of injuries for the orthopedic surgeon to treat [19]. This study has reflected what is already known in the literature regarding high rates of non-union, decreased post-operative functioning, and increased mortality.…”
Section: Discussionmentioning
confidence: 75%
“…In this setting, there may be a role for intramedullary fibular strut allograft use and or addition of a medial plate [38, 39]. Various aids to reduction in using MIPO technique, such as joystick pins, percutaneous clamps, and maximizing use of the plate as a reduction tool, have been described [19]. Further work is needed to determine an acceptable degree of reduction in application of MIPO technique, and whether the benefits of achieving anatomical reduction outweigh the invasiveness of the approach.Fig.…”
Background
The primary aim was to compare the outcomes of locked plating of closed distal femur periprosthetic and non-periprosthetic fractures by testing the hypothesis that outcomes would be worse in the periprosthetic group. The secondary aim of this study was to identify risk factors for non-union.
Methods
A single-center study over an 8-year period utilizing a retrospective cohort design was performed. Sixty-eight patients with periprosthetic fractures and 57 patients with non-periprosthetic fractures met inclusion criteria for the study. There was a significant difference between groups in mean age (80.1 years periprosthetic vs. 70.9 years non-periprosthetic (
p
< 0.001)). Statistical analysis between groups was used to assess the outcomes of time to union, incidence of non-union, post-operative functionality, incidence of complications, progression to revision surgery, and mortality. A secondary multivariable analysis was used to assess risk factors for non-union and factors positively associated with union.
Results
There were no significant differences in outcomes between groups. Union rates were 83.8% (57/68) in the periprosthetic group and 78.9% (45/57) in the non-periprosthetic group (
p
= 0.648). Comminution was identified as a significant risk factor for non-union (
p
= 0.005). Use of a submuscular technique had a significant positive association with union (
p
= 0.006).
Conclusions
Outcomes of surgical treatment for periprosthetic and non-periprosthetic distal femur fractures are similar. There is a significant risk of non-union in locked plating of both groups.
“…Locked plates inserted through MIPPO technique are now widely used and show better overall results as regard union rates and complication occurrence. 17 , 18 …”
Introduction:Distal femoral fractures in elderly population had recorded an increase in incidence in
the last 2 decades. Lateral distal femoral locking plating is considered one of the best
options especially when dealing with comminuted fractures but varus collapse of the
medial femoral condyle occurs frequently in patients with osteoporosis. Anatomical
reduction of the fracture with stable rigid fixation using double-plating approach
allows early mobilization of geriatric population and prevents varus collapse minimizing
the comorbidities in such fractures.Patients and Methods:Between September 2014 and January 2017, a prospective study on 23 patients with
comminuted osteoporotic distal femoral fractures managed through the double-plating
approach through a single parapatellar approach has been conducted. Only osteoporotic
geriatric patients with isolated distal femoral fractures were included.
Polytraumatized, open fractures, and fracture type 33-A1, 33-A2, and 33-B were excluded.
The mean age was 69.6 years (61-80). All patients have been evaluated as regard duration
of procedure, time to union, EQ-5D-5L score, the need of autologous bone grafts, range
of knee motion, and presence of complications.Results:The average follow-up was 14.1 months. The majority of fractures were type 33-C2 (13
patients). Average procedure time was 148 minutes (117-193 minutes). Mean EQ-5D-5 L
score was 83.8 (72-82). Average time to union was 9 months (3-12 months). Four (17.4%)
cases needed autologous bone graft after 6 months. No loss of reduction in any of the
cases was evident, although 6 (26%) cases had screw breakage or cutout in one of the
plate fixation. Two (8.7%) patient developed superficial wound infection and 1 (4.3%)
developed DVT.Discussion:This study aimed at evaluation of the success of double plating of distal femoral
fractures in geriatric population. different fixation methods were studied for reduction
and fixation of such a fracture such as external fixation, intramedullary nails and
lateral plating. the quality of fracture reduction, functional and radiological
outcomes, time to union, the need for bone grafting and complication are the main
debatable issues.Conclusion:Single-incision double-plating approach for distal femoral osteoporotic fractures is
effective and provides stable construct without reduction loss allowing early
rehabilitation. Delayed union and the need for bone graft are the major drawbacks for
this technique.
“…Progress has recently been observed in the field of fracture surgery, such as the rapid development of minimally invasive surgery and complex fracture management (1)(2)(3). These improvements can largely be attributed to research contributions from researchers and surgeons around the world.…”
Abstract. Worldwide research contributions have allowed the field of fracture surgery to progress. However, to the best of our knowledge, no studies have documented the main characteristics of publications from different countries. The present study aimed to determine the quantity and quality of worldwide research in fracture surgery. The Web of Science database was searched to identify fracture articles published between 2005 and 2014. The contributions of countries were evaluated based on paper and citation numbers, and the research output of each country was adjusted according to population size.
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