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Wardle B, Lynch JT, Staniforth T, Ward T, Smith P. Weightbearing versus non-weight bearing in geriatric distal femoral fractures: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02550-7. [PMID: 38777887 DOI: 10.1007/s00068-024-02550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Demographics of patients who sustain geriatric distal femoral fractures (DFF) match those of patients with neck-of-femur fractures but have limited evidence with which to support post-operative weightbearing protocols. PURPOSE This systematic review sought to identify any difference in outcomes for elderly patients with DFF who were allowed early versus delayed weightbearing postoperatively. METHODS DATA SOURCES: PubMed, Medline, Embase and The Cochrane Library, reference lists of retrieved articles. STUDY SELECTION English language papers published between January 2010 and February 2023 with AO-OTA type 33A, B and C femoral fractures as well as Lewis and Rorabeck Type I and II periprosthetic DFF surgically treated with either a lateral locking plate or retrograde intramedullary nail and an average patient age of ≥ 60 years. DATA EXTRACTION Studies were assessed for inclusion by two authors and quality was assessed using the MINORS tool. DATA SYNTHESIS Sixteen studies were included, Meta-analysis of non-union, malunion, infection, delayed union and implant complications was performed using Microsoft Excel and the MetaXL extension. The data on return to mobility were presented in narrative form. The analyses demonstrated no difference between the early and delayed weightbearing groups. CONCLUSIONS There are no significant differences in complication rates between early versus delayed weightbearing after surgery for DFF in an elderly population. The study results are limited by high heterogeneity and low-quality studies. High quality, prospective studies are needed to determine the ideal postoperative weightbearing protocol. LEVEL OF EVIDENCE Level III, Systematic Review and Meta-analysis of Level III studies. International Prospective Register of Systematic Reviews registration-Prospero CRD42022371460.
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Affiliation(s)
- Blaise Wardle
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia.
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia.
- The Australian National University, Canberra, Australian Capital Territory, Australia.
| | - Joseph T Lynch
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Thomas Staniforth
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
| | - Thomas Ward
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Paul Smith
- Trauma and Orthopaedic Research Unit, Yamba Drive, Canberra, Australian Capital Territory, 2605, Australia
- Canberra Hospital Orthopaedic Department, Canberra, Australian Capital Territory, Australia
- The Australian National University, Canberra, Australian Capital Territory, Australia
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Paulsson M, Ekholm C, Tranberg R, Rolfson O, Geijer M. Using a Traction Table for Fracture Reduction during Minimally Invasive Plate Osteosynthesis (MIPO) of Distal Femoral Fractures Provides Anatomical Alignment. J Clin Med 2023; 12:4044. [PMID: 37373737 DOI: 10.3390/jcm12124044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Fracture reduction and fixation of distal femur fractures are technically demanding. Postoperative malalignment is still commonly reported after minimally invasive plate osteosynthesis (MIPO). We evaluated the postoperative alignment after MIPO using a traction table with a dedicated femoral support. METHODS The study included 32 patients aged 65 years or older with distal femur fractures of all AO/OTA types 32 (c) and 33 (except 33 B3 and C3) and peri-implant fractures with stable implants. Internal fixation was achieved with MIPO using a bridge-plating construct. Bilateral computed tomography (CT) scans of the entire femur were performed postoperatively, and measurements of the uninjured contralateral side defined anatomical alignment. Due to incomplete CT scans or excessively distorted femoral anatomy, seven patients were excluded from analyses. RESULTS Fracture reduction and fixation on the traction table provided excellent postoperative alignment. Only one of the 25 patients had a rotational malalignment of more than 15° (18°). CONCLUSIONS The surgical setup for MIPO of distal femur fractures on a traction table with a dedicated femoral support facilitated reduction and fixation, resulting in a low rate of postoperative malalignment, despite a high rate of peri-implant fractures, and could be recommended for surgical treatment of distal femur fractures.
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Affiliation(s)
- Martin Paulsson
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Carl Ekholm
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Roy Tranberg
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
| | - Mats Geijer
- Department of Radiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Gothenburg, Sweden
- Department of Clinical Sciences, Lund University, 22185 Lund, Sweden
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Bae K, Kim G, Aldosari AM, Gim Y, Kwak YH. Sterile Silicone Ring Tourniquets in Limb Surgery: A Prospective Clinical Trial in Pediatric Patients Undergoing Orthopedic Surgery. J Pers Med 2023; 13:979. [PMID: 37373968 DOI: 10.3390/jpm13060979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Sterile silicone ring tourniquets (SSRTs) reduce intraoperative bleeding and provide a wide surgical view. Moreover, they reduce the risk of contamination and are cheaper than conventional pneumatic tourniquets. Our study describes the perioperative outcomes of sterile silicone ring tourniquet placement in pediatric patients undergoing orthopedic surgery. We prospectively recruited 27 pediatric patients aged < 18 years who underwent 30 orthopedic surgeries between March and September 2021. Following complete surgical draping, all operations were initiated by placing SSRTs. We investigated the demographic and clinical characteristics of these patients, details of the tourniquet used, and intra- and postoperative outcomes of tourniquet placement. Owing to the narrowness of tourniquet bands and tourniquet placement at the proximal ends of the extremities, wide surgical fields were achieved, without limiting joint range of motion. Bleeding control was effective. Tourniquets were applied and removed rapidly and safely, regardless of limb circumference. None of the patients experienced postoperative pain, paresthesia, skin problems at the application site, surgical site infections, ischemic problems, or deep vein thrombosis. SSRTs effectively reduced intraoperative blood loss and facilitated wide operative fields in pediatric patients with various limb sizes. These tourniquets allow quick, safe, and effective orthopedic surgery for pediatric patients.
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Affiliation(s)
- Kunhyung Bae
- Department of Orthopedic Surgery, Hanyang University Hospital, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Gisu Kim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Amaal M Aldosari
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
- Department of Orthopaedic Surgery, Al Noor Specialist Hospital, Makkah 24242, Saudi Arabia
| | - Yeonji Gim
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul 03722, Republic of Korea
| | - Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, 88, Olympic-ro, 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Lian X, Zhang H, Guo F, Wang Z, Zhao K, Hou Z, Zhang Y. Clinical effect of closed reduction minimally invasive fixation in intra-articular comminuted fractures of the femoral condyle. Front Surg 2023; 10:1085636. [PMID: 36816009 PMCID: PMC9935693 DOI: 10.3389/fsurg.2023.1085636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/16/2023] [Indexed: 02/05/2023] Open
Abstract
Objective To evaluate the advantages of double reverse traction closed reduction combined with minimally invasive fixation in treating femoral condylar comminuted fractures. Methods We retrospectively enrolled a total of 24 patients with femoral condylar comminuted fractures (AO = 33C3) admitted to Third Hospital of Hebei Medical University from March 2018 to February 2020. The patients were divided into two groups: experimental group (double reverse traction, n = 12) and control group (conventional surgery, n = 12). Patient demographics, fracture characteristics, operation time, incision length, and postoperative complications were then collected. The Hospital for Special Surgery (HSS) scores were recorded at the last follow-up visit. Results The average surgical time was 52.2 (41-73) min in the experimental group and 71.2 (45-103) min in the control group. In addition, the mean total incision length was 13.8 (11-17) cm in the experimental group and 16.3 (14-19) cm in the control group. The average HHS scores at the final follow-up were 86.3 (78-93) and 82.7 (76-90) in the experimental group and control group, respectively. Conclusion It was found that double reverse traction closed reduction combined with minimally invasive fixation can provide good repositioning results and functional extremity. Moreover, patients tolerate postoperative functional knee exercises well.
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Affiliation(s)
- Xiaodong Lian
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Heng Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Fan Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Zhongzheng Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Kuo Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China,Correspondence: Yingze Zhang ; Zhiyong Hou
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China,Orthopaedic Research Institution of Hebei Province, Shijiazhuang, China,NHC Key Laboratory of Intelligent Orthopaedic Equipment (The Third Hospital of Hebei Medical University), Shijiazhuang, China,Chinese Academy of Engineering, Beijing, China,Correspondence: Yingze Zhang ; Zhiyong Hou
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Displaced distal femur metaphyseal fractures: clinical and radiographic outcome in children aged 6-16 years treated by elastic stable intramedullary nailing. J Pediatr Orthop B 2021; 30:415-422. [PMID: 33038148 DOI: 10.1097/bpb.0000000000000820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fractures of the distal femur metaphysis (DFM) are rare. The main objective of this study was to retrospectively evaluate the clinical and radiographic outcomes of displaced DFM fractures in children treated by elastic stable intramedullary nailing (ESIN). We retrospectively reviewed 24 DFM fractures, including five pathological fractures secondary to non-ossifying fibroma (mean age, 10.9 years; range, 6-16) who underwent surgical treatment by ESIN. The patients were followed radiographically and clinically on a regular basis. Sixteen boys and eight girls were included in the study. Radiographically, all fractures healed, but five healed with complications. Most of the DFM fractures were transverse (n = 18, 75%), and all patients but two (91.7%) underwent closed reduction and stabilization of the fracture. All the patients were pain-free at their last follow-up. All regained full normal activities, although five patients developed a postoperative complication (20.8%). At the last follow-up visit, all fractures achieved union including the two cases of nonunion; moreover, none of the patients showed any signs of growth arrest or disturbances in radiological and clinical assessment. On the ESIN outcome measure scale, 12/24 patients (50%) had excellent results, 11/24 (45.8%) had good-satisfactory results and 1/24 (4.2%) had poor results. Fracture of the DFM can be challenging due to the relatively short length of the distal fragment, the proximity of the growth plate and the tendency of the distal fragment to displace. Following the surgical principles and understanding the anatomical constraints of the distal femur help to obtain satisfactory clinical and radiological results.
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Liu JF, Zhou ZF, Hou XD, Chen YX, Zheng LP. Hybrid locked medial plating in dual plate fixation optimizes the healing of comminuted distal femur fractures: A retrospective cohort study. Injury 2021; 52:1614-1620. [PMID: 33461771 DOI: 10.1016/j.injury.2021.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/31/2020] [Accepted: 01/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Dual plate fixation has been reported to be effective in the treatment of comminuted distal femur fractures (DFFs). However, optimized use of the medial plate and screws is less studied. This study aimed to evaluate the effect of a hybrid configuration of the medial plate in dual plate fixation of comminuted DFFs in promoting fracture healing. MATERIALS AND METHODS We retrospectively analyzed 62 patients with comminuted DFFs (AO/OTA 33-A3/33-C2/33-C3) from January 2015 to March 2020, who were either fixed with lateral locked plating augmented with hybrid locked medial plating (LP-HLMP, n = 32) or lateral locked plating (LLP, n = 30) alone. Specifically, compression screws were applied in the middle of the medial plate and flanked by locking ones at both ends. Baseline characteristics, radiological and clinical outcomes were reviewed and analyzed. Multivariate logistic regression analysis was used to identify predictive factors for early fracture healing, and risk factors for delayed union/nonunion. RESULTS Demographics including age, gender, smoking, diabetes, and injury mechanism were comparable between the two groups. Reduction quality was better in the LP-HLMP group (p < 0.001). Although the LP-HLMP group experienced longer duration of surgery (125 min vs. 100 min, p < 0.001), sign of healing at 3 months was more obvious in this group (75%, 24/32 vs. 30%, 9/30; p < 0.001). The LP-HLMP group also presented with higher union rate (93.8%, 30/32 vs. 56.7%, 17/30; p = 0.001) and lower reoperation rate (0%, 0/32 vs. 13.3%, 4/30; p = 0.049). Kolment score showed no statistical significance between the two groups. Multivariate analysis revealed that younger age (< 60 years) (OR 5.99, 95%CI 1.16 - 31.03; p = 0.001) and LP-HLMP fixation (OR 45.90, 95% CI 4.78 - 440.56; p = 0.001) predict early healing; while smoking (OR 17.80, 95% CI 2.41 - 131.49; p = 0.01) and fracture translation (OR 3.49, 95% CI 1.46 - 8.32; p = 0.01) were identified as risk factors for delayed union/nonunion. CONCLUSION Hybrid locked medial plating in this study favors the healing of comminuted DFFs and reduces reoperation. Additionally, smoking and suboptimal reduction (translation) predict delayed union/nonunion.
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Affiliation(s)
- Jun-Feng Liu
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Zi-Fei Zhou
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Xiao-Dong Hou
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yi-Xing Chen
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Long-Po Zheng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China; Shanghai Trauma Emergency Center, Shanghai, 200072, China; Orthopedic Intelligent Minimally Invasive Diagnosis & Treatment Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
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Zhang J, Wei Y, Li G, Wang J, Xu Y. Interfragmentary lag screw and locking plate combination in simple distal femoral fractures: A finite element analysis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2021; 55:9-15. [PMID: 33650504 DOI: 10.5152/j.aott.2021.20035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the strength of the locking plate and lag screw construct that is applied in two different working lengths on the simple distal femur fracture model with a finite element analysis (FEA) method. METHODS From the computerized tomography scan data of a 60-year-old healthy male, the AO/OTA 33A1-type fracture model was simulated; the fracture gap was stabilized with the models of locking plate construct with (groups C and D) or without an interfragmentary lag screw (groups A and B). Furthermore, 102-mm plate (groups A and C) and 82-mm plate working lengths (groups B and D) were tested using FEA. Two loading conditions (axial compression and torsion) were applied at the center of the femoral head. Construct stiffness, interfragmentary micromotion, and the peak von Mises stress (VMS) on the plate were assessed. RESULTS Group D provided the highest axial stiffness (1347 N/mm), and group A was the weakest (439 N/mm). With the lag screw, shear micromotion remained generally low compared with that without the screw for all axial and torsional load levels and for both plate working lengths, i.e., 0.23 mm with lag screw versus 0.43 mm without lag screw (102 mm working length, 700 N). The percentage decreases of shear micromotion under axial (350/700/1400 N) and torsional loads for the 102-mm working length were >22% and 73%, respectively; while those for the 82-mm working length were >28% and 33%, respectively. The reduction of axial micromotion was observed with the lag screw for all axial load levels as well as for both plate working lengths, i.e., 0.33 mm with lag screw versus 0.87 mm without lag screw (102-mm working length, 700 N). The percentage decreases of axial micromotion under axial loading (350/700/1400 N) for 102 mm and 82 mm working lengths were >42% and 50%, respectively. The peak VMS on the plate stayed generally low with lag screw compared with without lag screw throughout all tested load levels, as well as for both plate working lengths, i.e., 124.26 MPa versus 244.39 MPa (102 mm working length, 700 N). The percentage decreases of the peak VMS under axial (350/700/1400 N) and torsional loads for the 102-mm working length were >40% and 69%, respectively, while those for the 82-mm working length were >47% and 61%, respectively. CONCLUSION The current FEA concludes that in a simple distal femur fracture, adding a lag screw to a locking plate construct provides better torsional stability with a 102-mm plate working length and better axial stability with a 82-mm plate working length. Additionally, the strength of the materials is increased and implant failure can be minimized by using this technique.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, China;Department of Orthopaedics, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine - Health Sciences, Shanghai, China
| | - Yan Wei
- Department of Surgery, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine - Health Sciences, Shanghai, China
| | - Guoding Li
- Department of Orthopaedics, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine - Health Sciences, Shanghai, China
| | - Jian Wang
- Department of Orthopaedics, Pudong New Area People's Hospital affiliated to Shanghai University of Medicine - Health Sciences, Shanghai, China
| | - Youjia Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Arch Orthop Trauma Surg 2020; 140:1403-1412. [PMID: 32108255 DOI: 10.1007/s00402-020-03385-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Achieving adequate reduction is difficult when performing minimally invasive plate osteosynthesis (MIPO) in elderly patients with simple distal femur fracture. This study aimed to evaluate the elderly patients who had undergone percutaneous wiring-assisted reduction with MIPO for simple distal femur fractures to determine the effect of this technique on reduction quality and fracture union. MATERIALS AND METHODS Between January 2009 and September 2017, 56 patients (56 femurs) with displaced simple distal femur fractures treated with MIPO at three trauma centers were finally enrolled. The MIPO technique with percutaneous cerclage wire reduction was performed in 25 patients (Group A). Among them, 12 patients had a simple spiral metaphyseal fracture (Group A*). In comparison, MIPO without percutaneous cerclage wire reduction was performed in 31 patients (Group B). Among them, seven patients had a simple spiral metaphyseal fracture (Group B*). Medical records containing surgical records were retrospectively reviewed to investigate demographic data, comorbidities, complications, operative time, and fluoroscopic time. Radiographs were evaluated for assessing the quality of the reduction and fracture union. RESULTS The mean fracture union time of Group A* was 21.7 weeks, which was significantly shorter than that of Group B* (28.6 weeks). The mean coronal and sagittal angulation in Group A* was 0.6° and 0.7°, respectively, which were significantly lesser than those in Group B* (2.4° and 3.2°, respectively). Mean translation in Group A* was 1.43 mm, which was significantly shorter than that in Group B* (3.81 mm). Nonunion occurred in two patients in Group B. CONCLUSION Surgical treatment of simple spiral distal femur fractures with percutaneous cerclage wiring-assisted reduction and the MIPO technique in elderly patients resulted in better reduction and faster union time. Therefore, this technique could be a good solution if used in accordance with the indication.
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Jeong JJ, Park SE, Lee HH, Ji JH, Park MS, Park YT. Narrow locking compression plate vs long philos plate for minimally invasive plate osteosynthesis of spiral humerus shaft fractures. BMC Musculoskelet Disord 2019; 20:381. [PMID: 31421675 PMCID: PMC6698331 DOI: 10.1186/s12891-019-2757-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 08/08/2019] [Indexed: 12/28/2022] Open
Abstract
Background Our hypothesis was that minimally invasive plate osteosynthesis (MIPO) using long philos plate (LPP) would show better clinical and radiological outcomes and less complications than narrow locking compression plate (NLCP) for spiral humerus shaft fractures with or without metaphyseal fracture extension. Methods From January 2009 to May 2016, we retrospectively studied 35 patients who underwent MIPO for spiral humerus shaft fractures with or without metaphyseal fracture extension (AO classification 12 A, B, C except A3). Eighteen patients underwent MIPO with a 4.5 mm NLCP (group I) in the early period of this study, while 17 patients underwent MIPO with LPP (group II) in the later period. Range of motion (ROM), pre- and post-operative anteroposterior (AP) and lateral angulation of the fracture, operation time, amount of bleeding, and functional outcomes including American Shoulder and Elbow Surgeons score, University of California at Los Angeles score, and Simple Shoulder Test score were analyzed at the final follow up. Results All patients had complete bony union and achieved satisfactory functional outcomes except 2 patients. In LPP group, better outcomes in postoperative fracture angulation on X-ray and operation time (p < 0.05) were shown. But, two revision surgery with NLCP and bone graft was performed owing to 2 metal failures. Conclusions In spiral humeral shaft fractures, LPP group showed better fracture reduction on X-ray and shorter operation time except metal failure owing to weak fixation. Even though MIPO technique using LPP is easier and more accurate reduction method, rigid fixation should be considered.
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Affiliation(s)
- Jae-Jung Jeong
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Sang-Eun Park
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Hwan-Hee Lee
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Jong-Hun Ji
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea.
| | - Min-Sik Park
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
| | - Yong-Taek Park
- Department of Orthopaedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 520-2, Deahung-Dong, Jung-Gu, Daejeon, 302-803, South Korea
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Bai Z, Gao S, Hu Z, Liang A. Comparison of Clinical Efficacy of Lateral and Lateral and Medial Double-plating Fixation of Distal Femoral Fractures. Sci Rep 2018; 8:4863. [PMID: 29559667 PMCID: PMC5861122 DOI: 10.1038/s41598-018-23268-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 03/02/2018] [Indexed: 12/02/2022] Open
Abstract
The present study was performed to compare the clinical efficacy of lateral plate and lateral and medial double-plating fixation of distal femoral fractures and explore the indication of lateral and medial double-plating fixation of the distal femoral fractures. From March 2006 to April 2014, 48 and 12 cases of distal femoral fractures were treated with lateral plate (single plate) and lateral and medial plates (double plates), respectively. During the surgery, after setting the lateral plate for the distal femoral fractures, if the varus stress test of the knee was positive and the lateral collateral ligament rupture was excluded, lateral and medial double-plating fixation was used for the stability of the fragments. All the patients were followed up at an average period of 15.9 months. The average operation time, the intraoperative hemorrhage and the fracture union time of the two groups were compared. One year after operation, knee function was evaluated by the Kolmert's standard. There was no significant difference in the average operation time, intraoperative hemorrhage, fracture healing time and excellent and good rates of postoperative knee function between two groups. Positive Varus stress test during operation can be an indication for lateral and medial double-plating fixation of distal femoral fractures.
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Affiliation(s)
- Zhibiao Bai
- Department of Orthopaedics, The first Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Shichang Gao
- Department of Orthopaedics, The first Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| | - Zhenming Hu
- Department of Orthopaedics, The first Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Anlin Liang
- Department of Orthopaedics, The first Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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Piétu G, Ehlinger M. Minimally invasive internal fixation of distal femur fractures. Orthop Traumatol Surg Res 2017; 103:S161-S169. [PMID: 27867137 DOI: 10.1016/j.otsr.2016.06.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 02/07/2023]
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 present, retrograde nailing and minimally invasive percutaneous plate osteosynthesis (ideally by locking plate) are the two main techniques. Unfortunately, reports tend to compare implants rather than operative techniques, hindering solid conclusions. Lastly, the delineation of "distal femur fracture" is quite variable, sometimes situated well above the AO epiphyseal square. Meta-analyses find almost no difference between the two implants in minimally invasive procedures. The main advantage of the plate is its versatility, whereas nailing can be impossible in case of certain hip or knee prostheses, compound articular fracture or medullary canal obstruction by fixation material (nail, stem, screw, etc.). The role of arthroscopy is limited. Only a few case reports describe its use in reduction of epiphyseal fracture. In the last analysis, the surgeon's experience is more relevant to outcome than any particular implant.
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Affiliation(s)
- G Piétu
- Clinique chirurgicale orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - M Ehlinger
- Service de chirurgie orthopédique et traumatologique, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67089 Strasbourg cedex 1, France
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12
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Chung JY, Cho JH, Kweon HJ, Song HK. The use of interfragmentary positional screw in minimally invasive plate osteosynthesis for simple distal femur fractures in elderly patients: A retrospective, single-centre pilot study. Injury 2016; 47:2795-2799. [PMID: 27802890 DOI: 10.1016/j.injury.2016.10.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/30/2016] [Accepted: 10/24/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Minimally invasive plate osteosynthesis (MIPO) using locking plates has been used in distal femur fractures, but various problems, such as nonunion, malalignment, and implant failure, have been reported. Simple fractures sometimes have poorer outcomes than complex fractures. We studied elderly patients with simple fracture patterns who underwent open reduction followed by placement of a single positional screw to hold the reduced interfragmentary gap, and compared these cases with patients who underwent surgery using conventional MIPO techniques. PATIENTS AND METHODS A retrospective analysis was conducted on 80 cases of patients with distal femur fractures and simple fracture patterns (33-A1, A2, and C1). The mean age was 74 (60-90) years, and the mean follow-up period was 14 (12-25) months. Group A included 40 patients who underwent conventional MIPO technique while Group B included 40 patients who had surgery using positional screws. Interfragmentary gaps in Group B were reduced using percutaneous reduction clamps, and cortical screws were inserted to sustain the reduction. Then, locking plates were inserted using conventional MIPO techniques. RESULTS Bony union was achieved in all 80 cases, mean initial callus formation was observed in 11 weeks (8-13 weeks), and radiological union was observed in 27 weeks (15-54 weeks). Time to initial callus formation was not different, but radiologic union was achieved in 30 weeks (18-54 weeks) for Group A and 25 weeks (15-41 weeks) for Group B (p=0.006). No differences were seen in clinical function at 1year (p=0.580). Five cases of malalignment occurred in Group A (p=0.021). The rate of union during the 1-year period was significantly higher in group B than in group A (p=0.002). CONCLUSIONS In a distal femur fracture with a simple fracture pattern, using positional screws to sustain the reduced interfragmentary gap may achieve a more rapid union by reducing fracture gap. Though functional differences were not seen in follow-ups, patients can be expected to return to their normal lives earlier as union is achieved in a shorter time. Performing MIPO using positional screws to sustain the reduced interfragmentary gap after fracture reduction will be helpful in the treatment of simple femoral fracture.
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Affiliation(s)
- Jun Young Chung
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jae Ho Cho
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Heon Ju Kweon
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyung Keun Song
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.
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13
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Ehlinger M, Scheibling B, Rahme M, Brinkert D, Schenck B, Di Marco A, Adam P, Bonnomet F. Minimally invasive surgery with locking plate for periprosthetic femoral fractures: technical note. INTERNATIONAL ORTHOPAEDICS 2015; 39:1921-6. [DOI: 10.1007/s00264-015-2928-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 05/15/2015] [Indexed: 10/23/2022]
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Smith JRA, Halliday R, Aquilina AL, Morrison RJM, Yip GCK, McArthur J, Hull P, Gray A, Kelly MB. Distal femoral fractures: The need to review the standard of care. Injury 2015; 46:1084-8. [PMID: 25840789 DOI: 10.1016/j.injury.2015.02.016] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 02/04/2015] [Accepted: 02/19/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of distal femoral fractures in this population has not had the same emphasis. This study defines the epidemiology, current practice and outcomes of distal femoral fractures in four English centres. PATIENTS AND METHODS 105 patients aged 50 years or greater with a distal femoral fracture, presenting to four UK major trauma centres between October 2010 and September 2011 were identified. Data was collected using an adapted NHFD data collection tool via retrospective case note and radiograph review. Local ethics approval was obtained. RESULTS Mean age was 77 years (range 50-99), with 86% female. 95% of injuries were sustained from a low energy mechanism, and 72% were classified as either 33-A1 or 33-C1. The mean Parker mobility score and Barthel Independence Index were 5.37 (0-9) and 75.5 (0-100) respectively. Operative management was performed in 84%, and 86% had their surgery within 36 h. Three quarters were fixed with a peri-articuar locking plate. There was no consensus on post operative rehabilitation, but no excess of complications in the centres where weight bearing as tolerated was the standard. 45% were seen by an orthogeriatrician during their admission. Mean length of stay was 29 days. Mortality at 30 days, 6 months, and 1 year was 7%, 16% and 18% respectively. DISCUSSION This study demonstrates that the distal femoral and hip fracture populations are similar, and highlights the current disparity in their management. The metrics and standards of care currently applied to hip fractures should be applied to the treatment of distal femoral fractures. Optimal operative treatment and rehabilitation remains unclear, and is in need of further research.
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Affiliation(s)
- James R A Smith
- Department of Orthopaedics, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom.
| | - Ruth Halliday
- Department of Orthopaedics, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom
| | - Alexander L Aquilina
- Department of Orthopaedics, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - Rory J M Morrison
- Department of Orthopaedics, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Grace C K Yip
- Department of Orthopaedics, Addenbrooks Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - John McArthur
- Department of Orthopaedics, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, United Kingdom
| | - Peter Hull
- Department of Orthopaedics, Addenbrooks Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, United Kingdom
| | - Andrew Gray
- Department of Orthopaedics, Royal Victoria Infirmary, Queen Victoria Rd, Newcastle upon Tyne NE1 4LP, United Kingdom
| | - Michael B Kelly
- Department of Orthopaedics, Southmead Hospital, Southmead Road, Bristol BS10 5NB, United Kingdom
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Ehlinger M, Dujardin F, Pidhorz L, Bonnevialle P, Pietu G, Vandenbussche E. Locked plating for internal fixation of the adult distal femur: influence of the type of construct and hardware on the clinical and radiological outcomes. Orthop Traumatol Surg Res 2014; 100:549-54. [PMID: 25153482 DOI: 10.1016/j.otsr.2014.06.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/30/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal femoral fractures are rare and serious. Along with traditional internal fixation, new, dedicated hardware have appeared (distal nails, locked plating). We report the results of a multicenter prospective study of these fractures treated with locked plating. HYPOTHESIS The short-term results are satisfactory and related to the type of construct and the hardware used, with better results for elastic assemblies and titanium implants. MATERIALS AND METHODS From June 2011 to May 2012, 92 patients, mean age 64 years, were included in 12 centres. The fractures were classified as follows: 44 type A, 7 type B, and 41 type C according to the AO classification. Thirteen fractures were open. The plates were uniaxial. The assemblies were elastic in 52 cases, rigid in 26, and unconventional in 14. RESULTS Seventy-six patients underwent a radiological follow-up at 6 months and 66 patients had a clinical result evaluated at 1 year. The mean range of motion was 100° and the mean IKS score was 122. The bone union rate was 87% within 12 weeks. Seven valgus, two varus, ten flexion deformities, and three recurvatum greater than 5° were observed (19.5%). Revisions involved two cases with loss of fixation, five cases of infection, and one case of arthrofibrosis (requiring arthroscopic arthrolysis). Secondary bone grafting was carried out in seven cases (four successfully). No influence of the type of assembly or the hardware used was demonstrated. DISCUSSION The results remain modest, underscoring the severity of these fractures. Neither the type of construct nor the hardware used influenced the radiological and clinical outcomes. The hypothesis was not confirmed. LEVEL OF EVIDENCE Level IV prospective, non-comparative study.
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Affiliation(s)
- M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - F Dujardin
- Service de chirurgie orthopédique et traumatologique, 1, rue de Germont, 76000 Rouen, France
| | - L Pidhorz
- Service de chirurgie orthopédique et traumatologique, 194, avenue Rubillard, 72037 Le Mans, France
| | - P Bonnevialle
- Institut de l'appareil locomoteur, département d'orthopédie traumatologie, hôpital Riquet, place Baylac, 31052 Toulouse cedex, France
| | - G Pietu
- Service de chirurgie orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - E Vandenbussche
- Service de chirurgie orthopédique et traumatologique, université René-Descartes, hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris cedex, France
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16
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Minimally Invasive Plate Osteosynthesis in the Elderly Patient. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res 2013; 99:353-60. [PMID: 23518071 DOI: 10.1016/j.otsr.2012.10.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/15/2012] [Accepted: 10/29/2012] [Indexed: 02/02/2023]
Abstract
Fractures of the distal femur are rare and severe. The estimated frequency is 0.4% with an epidemiology that varies: there is a classic bimodal distribution, with a frequency peak for men in their 30s and a peak for elderly women; however, at present it is found predominantly in women and in the elderly with more than 50% of patients who are over 65. The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. The anatomy of the distal femur explains the three major types of fracture. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. A non-surgical treatment is a rare option. The aim of this report was to provide an update on the existing surgical solutions for the management of these fractures and describe details of the surgical technique applicable to these injuries. Recent radiological, clinical and biomechanical data published in the literature are reported to compare different surgical options.
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Affiliation(s)
- M Ehlinger
- Department of Orthopaedics and Trauma Surgery, Hautepierre Teaching Hospital Center, Strasbourg Academy Hospital Group, 1, avenue Molière, 67098 Strasbourg cedex, France.
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Ducrot G, Bonnomet F, Adam P, Ehlinger M. Treatment of distal humerus fractures with LCP DHP™ locking plates in patients older than 65 years. Orthop Traumatol Surg Res 2013; 99:145-54. [PMID: 23453914 DOI: 10.1016/j.otsr.2012.12.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 07/27/2012] [Accepted: 12/30/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Fractures of the distal humerus are often complex and therefore challenging to treat. In elderly patients with decreased bone strength due to osteoporosis, strong fixation is crucial to allow resuming early motion that guarantees a good functional outcome as well as minimising mechanical complications. Locked implants meet these requirements. Here, we report outcomes in a uniform series of patients older than 65 years with distal humerus fractures managed with LCP DHP(®) (Synthès) fixation. Our objective was to evaluate the efficacy and limitations of this technique. HYPOTHESIS LCP DHP provides strong fixation of osteoporotic bone and leads to good clinical and radiological outcomes. MATERIALS AND METHODS We retrospectively studied 46 consecutive patients (2004-2010) with a mean age of 80 years including 15 with extra-articular and 31 with articular distal humerus fractures. At presentation, 11 complications were noted in nine patients (compound fractures and trauma-related nerve injuries). The transolecranon approach was used in 31 patients. Mean duration of immobilisation was 2.7 weeks in 33 patients. RESULTS Forty-three patients were re-evaluated after a mean follow-up of 25 months (range, 10-64 months); two patients died and one was lost to follow-up. Flexion was 127° and loss of extension was 23°, producing an average range of motion of 104°. Functional recovery was highly satisfactory with a Mayo Clinic Performance Score of 87 (70-100) and 95% of good and very good results. Postoperative complications consisted of infection (n=3), metaphyseal non-union (n=2), ulnar nerve injury (n=6), transient radial nerve palsy (n=1), and peri-articular ossification (n=4). Compound fracture and worse AO fracture type were associated with worse functional outcomes. DISCUSSION Despite the high complication rate, functional recovery was similar to that reported in previous case series, including after arthroplasty. Furthermore, the rate of mechanical complications was lower. Thus, our working hypothesis was confirmed. LEVEL OF EVIDENCE Level IV retrospective non-comparative study.
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Affiliation(s)
- G Ducrot
- Department of Orthopaedic and Trauma Surgery, de Hautepierre Hospital, Strasbourg Academic Hospital Group, 1, avenue Molière, 67098 Strasbourg, France.
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Ducrot G, Ehlinger M, Adam P, Di Marco A, Clavert P, Bonnomet F. Complex fractures of the distal humerus in the elderly: is primary total elbow arthroplasty a valid treatment alternative? A series of 20 cases. Orthop Traumatol Surg Res 2013; 99:10-20. [PMID: 23273377 DOI: 10.1016/j.otsr.2012.10.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 07/24/2012] [Accepted: 10/05/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Distal humerus fractures are fairly rare. But as our population ages, these fractures become more complex and the choice of treatment more delicate. Poor bone quality results in many technical problems and the fixation hardware stability remains at risk. The goal of this study was to evaluate the functional recovery and morbidity of complex distal humerus fractures in elderly patients when treated with elbow prosthesis. HYPOTHESIS Good functional recovery can be achieved with a total joint replacement. PATIENTS AND METHODS This series consisted of 20 patients (18 women and two men) having an average age of 80years (range 65-93, median 80). Based on the AO classification, there were two Type A2 fractures, two Type B fractures, 15 Type C fractures and one fracture that could not be classified because of previous rheumatoid disease history at this elbow. Two fractures were open. In two cases, the olecranon was also fractured. Treatment consisted of the implantation of a Coonrad-Morrey, hinge-type total elbow prosthesis (Zimmer(®), Warsaw, IN, USA). The Mayo Clinic surgical approach was used 17 times and the transolecranon approach was used three times. Primary arthroplasty was performed in 19 cases and the surgery was performed after six weeks of conservative treatment (diagnostic delay) in one case. Unrestricted motion was allowed after surgery, but a maximum of 0.5kg could be carried during the first 3months; this was subsequently increased to 2.5kg. RESULTS Fifteen of the 20 patients were available for reevaluation with an average follow-up of 3.6years (range 1.7-5.5, median 3.4). Four patients had died and one was lost to follow-up. The average range of motion was 97° (range 60-130°), comprising an average flexion of 130° (range 110-140°) and average loss of extension of 33° (range 0-80°). Pronation and supination were normal. The average Mayo Elbow Performance Score (MEPS) was 83 (range 60-100, median 80). X-rays revealed seven cases of radiolucent lines, with two being progressive. There was no visible wear of the polyethylene bushings at the hinge. Six patients had moderate periarticular heterotopic ossification. The two cases of olecranon osteotomy and one case of olecranon fracture had healed. There were no surgical site infections but two cases of ulnar compression, one of which required neurolysis. There was one case of humeral component loosening after 6years, but the implant was not changed. DISCUSSION The clinical range of motion results were comparable to published data. The functional scores were slightly lower, mainly because of the pain factor. The initial results were encouraging and consistent with published data as long as the indications were well-chosen. Based on this retrospective study, total elbow arthroplasty can be a valid alternative in the surgeon's treatment armamentarium for complex distal humerus fractures in elderly patients who have moderate functional demands. Our results support our hypothesis, since we found good functional recovery without associated morbidity. LEVEL OF EVIDENCE Level IV retrospective study without comparator.
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Affiliation(s)
- G Ducrot
- Orthopaedic and Trauma Surgery Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg, France.
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Liporace FA, Yoon RS. An adjunct to percutaneous plate insertion to obtain optimal sagittal plane alignment in the treatment of pilon fractures. J Foot Ankle Surg 2011; 51:275-7. [PMID: 22177831 DOI: 10.1053/j.jfas.2011.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Indexed: 02/03/2023]
Abstract
Advances in the surgical technique and implant technology have offered significantly improved options for patients in the acute fracture setting. In particular, regarding extra- and intra-articular fractures of the distal tibia, percutaneous plating options have helped to minimize soft tissue stripping, maintain osseous vascularity, and increase the healing potential and fracture stabilization. However, even with the advent of new, minimally invasive technologies, misalignment after open reduction can still occur. In the present report, we present a simple, reproducible technique that we have used to consistently achieve optimal sagittal plane alignment of fixation during percutaneous plating of fractures of the distal tibia.
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Affiliation(s)
- Frank A Liporace
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, NJ, USA.
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