1
|
Abboud J, Moussa MK, Sader Z, Favreau H, Bégué T, Flecher X, Ehlinger M. Management of periprosthetic femoral fractures following total knee arthroplasties using locking plates or intramedullary nailing. Comparative study of 567 cases. Orthop Traumatol Surg Res 2024; 110:103814. [PMID: 38224866 DOI: 10.1016/j.otsr.2024.103814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 09/20/2023] [Accepted: 10/16/2023] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Proximal femur fractures in elderly patients pose a common problem that requires surgical management. The main objective of this study was to compare the results of treatment by locked plate (LP) and by anterograde (AIN) or retrograde (RIN) intramedullary nailing. The secondary objective was to analyze the complications related to each group. The hypothesis of this study was that the radiological and clinical results of each group were comparable. MATERIALS AND METHODS The data of 438 patients from 8 centers were studied retrospectively with 365 LP and 69 cases of intramedullary nailing (49 AIN and 20 RIN). The groups were comparable in terms of mean age (75±2years), mean preoperative Parker score (5.3±0.5) and mean KOOS score (74±2). Most patients lived at home before their fracture [n=375 (86%)]. At follow-up, the joint range of motion, the KOOS and Parker scores, living premises, the time required to regain full weight-bearing, the time required for consolidation as well as the reduction alignment: frontal, sagittal, horizontal. RESULTS The average follow-up was: 79±2weeks (65 to 82). The functional and radiological results were comparable, although nailing allowed a faster return to weight-bearing (1±2weeks for nailing versus 7±2weeks for LP, p=0.048) and a better postoperative Parker score (5.5±0.5 for nailing versus 4.7±0.2 for LP, p=0.045). Rotational malalignment in femoral nailing was often in the direction of internal rotation, compared to the LP (p=0.045). Complications were comparable with the exception of mortality, which was more frequent for LP [22.5% in the LP group versus 13% in the nailing group (p=0.045)]. Complications were categorized as: mechanical complications 6.8% of LP, 5.7% of nailing (p>0.05), infections [11% of LP, 5.8% of nailing (p>0.05)], surgical revisions [2% of LP, 10% of nailing (p>0.05)]. DISCUSSION AND CONCLUSION The hypothesis was refuted. These results show that nailing conferred a faster recovery of weight-bearing, a better Parker score, and is associated with a lower mortality rate. The morbidity rate is comparable between the two techniques. Indeed, when the indication for osteosynthesis by LP or by nailing is made, and both choices are technically justifiable, it would be prudent to favor the technique, which carries the least risk, which in this case is nailing. This conclusion must, however, be taken in to consideration with regard to the reduced number of nailing. A larger series of nailing, particularly retrograde, would be necessary to be able to confirm this last difference between the 2 groups. LEVEL OF EVIDENCE IV; comparative retrospective study.
Collapse
Affiliation(s)
- Johnny Abboud
- Service d'Orthopédie et Traumatologie, Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar cedex, France.
| | - Mohamad K Moussa
- Service d'Orthopédie et Traumatologie, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, France
| | - Ziad Sader
- Service d'Orthopédie et Traumatologie, Hôpitaux Civils de Colmar, 39, avenue de la Liberté, 68024 Colmar cedex, France
| | - Henri Favreau
- Service d'Orthopédie et Traumatologie, Hôpital de Hautepierre - Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Thierry Bégué
- Service d'Orthopédie et Traumatologie, Hôpital Antoine-Béclère - Hôpitaux Universitaires Paris-Sud, Paris, France
| | - Xavier Flecher
- Service d'Orthopédie et Traumatologie, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - Matthieu Ehlinger
- Service d'Orthopédie et Traumatologie, Hôpital de Hautepierre - Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| |
Collapse
|
2
|
Lim EJ, Cho JW, Shon OJ, Oh JK, Hwang KT, Lee GC. Far cortical locking constructs for fixation of distal femur fractures in an Asian population: A prospective observational study. J Orthop Sci 2024:S0949-2658(24)00052-6. [PMID: 38570286 DOI: 10.1016/j.jos.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 03/07/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The stiffness of locked plates suppresses healing process, prompting the introduction of far cortical locking to address this issue. This study aimed to demonstrate the clinical efficacy of far cortical locking constructs in treating distal femoral fractures in an Asian population. METHODS This multicenter prospective observational study was conducted at four university hospitals between February 2018 and February 2021. Demographic data, the presence of metaphyseal comminution, and surgical fixation details were recorded. Clinical outcomes, including single-leg standing, EQ-5D, and EQ-VAS scores, and radiologic outcomes, including the RUST score of each cortex, were evaluated and compared according to the presence of metaphyseal comminution. RESULTS There were 37 patients (14 men and 23 women) with a mean age of 67.3 ± 11.8 years. Twenty-two patients had metaphyseal comminution (59%), and 15 presented simple fractures in metaphyseal areas. Four patients (13%) could stand on one leg >10s at 6 weeks, and 24 patients (92%) at 1 year. EQ-5D increased from 0.022 ± 0.388 to 0.692 ± 0.347, and the mean EQ-VAS 51.1 ± 13.1 to 74.1 ± 24.1 between discharge (n = 37) and post-operative 1 year (n = 33), respectively. RUST score presented increment for time, from 6.2 ± 1.8 at 6 week to 11.6 ± 1.1 at 1 year. Radiological healing demonstrated rapid increase from week 6 (16/28, 43%) to month 3 (27/31, 87%), with no obvious increase was observed in 6 months (23/26, 89%) or 12 months (25/28, 89%). Simple metaphyseal fractures presented significantly higher RUST scores at 6 weeks and 3 months, but there was no difference in RUST scores at 6 months or 1 year according to metaphyseal comminution. CONCLUSIONS Plate constructs with far cortical locking screws provided safe and effective fixation for distal femoral fractures, with consistent radiological and clinical results, regardless of metaphyseal comminution.
Collapse
Affiliation(s)
- Eic Ju Lim
- Department of Orthopaedic Surgery, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Jae-Woo Cho
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Daegu, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Kyu Tae Hwang
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Republic of Korea.
| | - Gwang Chul Lee
- Department of Orthopaedic Surgery, School of Medicine, Chosun University, Gwangju, Republic of Korea.
| |
Collapse
|
3
|
Wulbrand C, Müller F, Füchtmeier B, Hanke A. Therapy aspects of peri-implant femoral fractures-a retrospective analysis of 64 patients. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02508-9. [PMID: 38530409 DOI: 10.1007/s00068-024-02508-9] [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: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE The incidence of peri-implant femoral fractures (PIFF) is increasing. Information regarding outcomes, timing of surgery, risk factors, and a clinically applicable treatment algorithm are lacking. The aim of this study was to identify outcome-related risk factors and to derive a treatment algorithm. METHODS Sixty-four PIFFs treated between 01.01.2006 and 31.12.2020 in a level I trauma centre were evaluated retrospectively for fracture pattern, surgical technique, risk factors, complications, and 1-year mortality. The study was approved by the ethics committee (No. 21-2714-104). RESULTS One-year mortality was 24.1%. Surgical complications occurred in 4.7%, and general complications in 15.6% of the patients. General complications, low haemoglobin level at admission, elevated CHA2DS2-VASc, and Charlson score resulted in increased 1-year mortality. Time to surgery > 24 h did not increase complication or mortality rates. The three predominant fracture patterns were fractures close or distal to cephalomedullary nails, close or proximal to distal lateral plates, and close or distal to sliding hip screws. Recommendations for surgical treatment were derived: Osteosynthesis should enable as much weight-bearing as possible; the initial implant should only be removed, if this is essential for the new osteosynthesis; lateral locking plates should span the whole femur; antegrade nails should have a cephalomedullary component to avoid consecutive femoral neck fractures; implants should overlap to reduce the risk of consecutive inter-implant fractures. CONCLUSION Risk factors for 1-year mortality in patients with PIFFs were identified. A treatment algorithm and general principles for surgery of PIFFs were developed.
Collapse
Affiliation(s)
- Christian Wulbrand
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany.
| | - Franz Müller
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Bernd Füchtmeier
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Alexander Hanke
- Department for Trauma, Orthopaedics and Sports Medicine, Hospital Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| |
Collapse
|
4
|
Meyer AP, Large TM. Early peri-implant fractures after distal femur fracture locked plating? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03398-6. [PMID: 36201033 DOI: 10.1007/s00590-022-03398-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/28/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To report the peri-implant fracture rates after locked plating of distal femur fractures and examine risk factors. METHODS Over a 7 year period, 89 AO/OTA 33A/C distal femur fractures were identified and reviewed. After excluding treatment with intramedullary nails, age under 50, those with the proximal femur protected, or those without 6 months of follow-up, 42 distal femur fractures in 41 patients, mean age 72.3 were studied. All were treated with lateral locked plating of distal femur fractures. The details of the constructs were recorded. Mean follow-up was 562 days (18.7 months). RESULTS 3/42 were open injuries, 9/42 were type C, 16/42 were type A, and 17 were periprosthetic above a knee arthroplasty. Two patients were treated with a dynamic plating construct using all far-cortical locking (FCL) screws in the diaphysis. 40 patients were treated with a variety of non-dynamic diaphyseal constructs including locking, non-locking, and four with 1-2 FCL screws distally. There was one asymptomatic nonunion. 2/2 patients in the dynamically plated group experienced a peri-implant fracture versus 1/40 in the non-dynamically plated group (p = 0.001). 3/9 with an all-locked construct versus 0/25 patients with a most proximal non-locking screw experienced a fracture. CONCLUSIONS The overall peri-implant fracture risk was 7.1% (3/42), 3/17 patients with a locking screw most proximal experienced a peri-implant fracture, 3/9 with an all-locking construct, and 2/2 patients with a dynamic construct experienced a fracture. These findings merit additional clinical and biomechanical study.
Collapse
Affiliation(s)
- Anna P Meyer
- Emory University Department of Orthopedic Surgery, Grady Memorial Hospital, Atlanta, GA, 30301, USA
| | - Thomas M Large
- Emory University Department of Orthopedic Surgery, Grady Memorial Hospital, Atlanta, GA, 30301, USA.
- Mission Hospital, Orthopedic Trauma Services, Asheville, NC, USA.
| |
Collapse
|
5
|
Battut T, Argenson JN, Flecher X, Le Baron M. Comparison of morbidity-mortality and functional results between implant exchange and internal fixation by plate for periprosthetic femoral fracture in total knee arthroplasty: A 52-case series. Orthop Traumatol Surg Res 2022; 108:103293. [PMID: 35477035 DOI: 10.1016/j.otsr.2022.103293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 08/30/2021] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Surgical options for periprosthetic femoral fracture in total knee arthroplasty (TKA) are controversial. The present retrospective study compared morbidity, mortality and functional results between implant exchange (group IE) and internal fixation by plate (group IF). The study hypothesis was that implant exchange does not give rise to more complications than plate fixation and that functional results are equivalent. METHODS Fifty-two femoral fractures in contact with a TKA implant were studied. The IE and IF groups (n 32 and 20, respectively), were comparable for age, gender and ASA score. Mean age was 80.5 years (range, 53-96 years). Morbidity and mortality were assessed on Clavien score; functional assessment used the KOOS questionnaire. RESULTS Mortality was 50% in group IF and 40% in group IE (p=0.4817). One patient was lost to follow-up. Complications were seen in 15 group IF patients (48.4%) versus 5 in group IE (26.3%) (p=0.14760), with infection in 5 (16.1%) and 2 patients (10.5%) respectively (p=0.69475). In both groups, 9 patients (i.e., 28.1% and 40% respectively) showed grade 2 complications (p=1). Revision surgery was performed in 8 grade 3b patients (25%) in the IF group and in 3 (15%) in the IE group (p=1). Mean KOOS score was 40 (range, 20-72) in IF and 65 (range, 50-93) in IE (p=0.0004). CONCLUSION Morbidity and mortality were comparable between implant exchange and plate fixation for periprosthetic femoral fracture in TKA. KOOS functional scores were better with implant exchange. Implant exchange may be suited to complex fracture with stable implant. LEVEL OF EVIDENCE IV, observational study.
Collapse
Affiliation(s)
- Thibault Battut
- Hôpital d'Instruction des Armées Laveran, 34, boulevard Laveran, 13013 Marseille, France.
| | - Jean-Noël Argenson
- Institut du Mouvement et de l'Appareil Locomoteur, Centre Hospitalo-Universitaire Sud, hôpital Sainte-Marguerite, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Xavier Flecher
- Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, Chemin des Bourrely, 13015 Marseille, France
| | - Marie Le Baron
- Institut du Mouvement et de l'Appareil Locomoteur, CHU Marseille Nord, Chemin des Bourrely, 13015 Marseille, France
| |
Collapse
|
6
|
Practical approach to the native distal femur fractures in the elderly: A rapid review over the recent trends. Injury 2022; 53:2389-2394. [PMID: 35644641 DOI: 10.1016/j.injury.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
Significant work has been done in recent years on treatment strategies for distal femur fractures. Inclusive reviews on periprosthetic fractures of distal femur have been carried out recently, but there is a lack of such reviews on the subject of native distal femur fractures in the recent literature. In this narrative review, we are set out to address the latest updates on geriatric non-periprosthetic distal femur fractures, and perform a rapid review over different treatment options, arriving at a summarized proposed treatment algorithm.
Collapse
|
7
|
Kim JW, Oh CW, Park KH, Oh JK, Yoon YC, Kim JK. Peri-implant atypical femoral fracture after nail or plate osteosynthesis. J Orthop Sci 2022; 27:866-875. [PMID: 34052080 DOI: 10.1016/j.jos.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/23/2021] [Accepted: 04/12/2021] [Indexed: 02/09/2023]
Abstract
BACKGROUND A lack of scientific information regarding the risk factors and diagnosis of peri-implant atypical femoral fracture (PI-AFF) exists. We report a case series of developed PI-AFF with a nail or plate construct wherein prior femoral fractures were already healed after osteosynthesis. This study aimed to identify the cause and risk factors of PI-AFF and to devise a preventive method based on this. METHODS We identified 11 PI-AFFs displaying features of AFFs. All patients were ambulant females (mean age, 74.9 years). The mean T-score of the femur measured by DEXA (Dual Energy X-ray Absorptiometry) scan was 3.5. Osteosynthesis was performed with a plate and an intramedullary nail in six and five patients, respectively. Possible risk factors were investigated, including the used implant, the medication of bisphosphonate, the characteristics of previous fracture (AFF or non-AFF), and the co-existence of AFF on the contralateral side. RESULTS The PI-AFFs developed at an average of 6.6 years from the time of prior fracture. All fractures were located at the screw through the plate or nail. Regarding anatomic locations, seven and four fractures were at the subtrochanteric area and diaphysis, respectively. Diaphyseal PI-AFFs occurred in plating cases, all of which were associated with excessive femoral bowing. Subtrochanteric PI-AFFs included all five patients with nail fixation, which occurred near a proximal interlocking screw. Six of the 11 patients were on bisphosphonate treatment before or at the time of fracture. The duration of bisphosphonate treatment was 6 years on average. Concerning the previous femoral fractures, seven and four patients were AFF and non-AFF, respectively. Considering the pathology on the contralateral leg, eight had suffered diaphyseal AFF. Four patients were treated nonoperatively. Seven patients needed an operation; 6 of them healed after reconstruction nailing, and one needed hip arthroplasty because of the associated displaced femoral neck fracture. CONCLUSIONS PI-AFFs may develop through the screw hole at the subtrochanteric or diaphyseal area due to femoral fragility and stress riser effect of the implant. An improved osteosynthesis strategy may be necessary to avoid PI-AFFs when fixing osteoporotic femoral fractures.
Collapse
Affiliation(s)
- Joon-Woo Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea.
| | - Kyeong-Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea
| | - Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - June-Kyu Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-ro, Jung-gu, Daegu, 41944, Republic of Korea
| |
Collapse
|
8
|
Grønhaug KML, Dybvik E, Gjertsen JE, Samuelsson K, Östman B. Subsequent ipsi- and contralateral femoral fractures after intramedullary nailing of a trochanteric or subtrochanteric fracture: a cohort study on 2012 patients. BMC Musculoskelet Disord 2022; 23:399. [PMID: 35484538 PMCID: PMC9047323 DOI: 10.1186/s12891-022-05340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The literature is inconclusive as to whether an intramedullary nail changes the distribution of a subsequent ipsi- or contralateral fracture of the femur. We have compared the incidence, localisation, and fracture pattern of subsequent femoral fractures after intramedullary nailing of trochanteric or subtrochanteric fractures in patients without previous implants in either femur at the time of surgery. Methods Retrospective analysis was performed of a two-centre cohort of 2012 patients treated with a short or long intramedullary nail for the management of trochanteric or subtrochanteric fracture between January 2005 and December 2018. Subsequent presentations with ipsi- and contralateral femoral fractures were documented. Only patients with no previous femoral surgery performed, other than the index nailing were followed. Odds ratios (ORs) for subsequent femoral fracture were calculated using robust variance estimates in logistic regression. Results The mean age of the cohort was 82.4 years and 72.1% were female. The total number of patients presenting with subsequent femoral fractures was 299 (14.9%). The number of patients presenting with subsequent ipsilateral and contralateral femoral fractures was 51 (2.5%) and 248 (12.3%) respectively (OR 5.0; CI 3.7–6.9). Twenty-six (8.7%) of all subsequent femoral fractures occured in the ipsilateral shaft, 14 (4.7%) in the ipsilateral metaphyseal area, one (0.33%) in the contralateral shaft, and three (1.0%) in the contralateral metaphysis (OR 10; CI 3.6–29). Conclusion An intramedullary nail significantly changes the fracture pattern in the event of a second low-energy trauma, reducing the risk of subsequent proximal ipsilateral femoral fractures and increasing the risk of subsequent ipsilateral femoral fractures in the shaft and distal metaphyseal area compared with the native contralateral femur.
Collapse
Affiliation(s)
- Kirsten Marie Larsen Grønhaug
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Sarpsborg, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Eva Dybvik
- Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Bengt Östman
- Department of Orthopaedic Surgery, Østfold Hospital Trust, Sarpsborg, Norway
| |
Collapse
|
9
|
Hochner-Ger A, Schermann H, Tordjman D, Atlan F, Pritsch T, Rosenblatt Y. Peri-Implant Olecranon Tip Fracture: Complication of Olecranon Osteotomy Plating. Orthopedics 2021; 44:e583-e587. [PMID: 34292836 DOI: 10.3928/01477447-20210618-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Several anatomic plates for fixation of the olecranon after a fracture or an osteotomy are commercially available. They serve as an alternative for tension band wiring, which is associated with a relatively high complication rate. Plating of the olecranon reportedly might result in nonunion or malunion and eventually may require revision surgery or plate removal because of skin irritation. The authors describe a proximal periprosthetic avulsion fracture of the tip of the olecranon as a unique complication associated with the use of an anatomic plate for fixation of an olecranon osteotomy. This retrospective case series included 35 patients with comminuted distal humerus fractures treated by open reduction and internal fixation through an olecranon osteotomy with an anatomic olecranon plate. Of the 35 patients, 6 (17.1%) had postoperative olecranon tip fracture, just proximal to the osteotomy site. In all cases, the fracture line coursed through the proximal cluster of screws situated on the proximal part of the plate. Avulsion fractures of the tip of the olecranon after plating of the olecranon osteotomy could have occurred as a result of biomechanical factors. The short design of the proximal part of the plate and the high screw density in the proximal part of the olecranon could lead to increased mechanical stress during contraction of the triceps. This complication should prompt further biomechanical evaluation of the plate design. [Orthopedics. 2021;44(4):e583-e587.].
Collapse
|
10
|
Peri-implant fractures of the upper and lower extremities: a case series of 61 fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:467-474. [PMID: 34018018 DOI: 10.1007/s00590-021-03005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To assess outcomes for patients who sustained peri-implant fractures (PIFs). METHODS Medical records of patients who sustained a PIF were reviewed for demographic, injury, outcome, and radiographic data. PIFs were classified using a reproducible system and stratified into cohorts based on fracture location. Clinical outcomes were evaluated for each cohort. RESULTS Fifty-six patients with 61 PIFs with at least 6 months of follow-up were included. The mean age of the cohort was 60.4 ± 19.5 years. Twenty-two (36.1%) PIFs occurred in males, while 39 (63.9%) occurred in females. Fifty-two (85.2%) PIFs were sustained from a low-energy injury mechanism. PIFs were most often treated with plate/screw constructs (50.8%). Complications included: 6 (9.8%) nonunions, 5 of which were successfully treated to healing, 5 (8.2%) fracture related infections (FRI), and 1 (1.6%) hardware failure. Sixty (98.4%) PIFs ultimately demonstrated radiographic healing. CONCLUSION PIFs are usually treated surgically and have a relatively high incidence of complications, with nonunion in femoral PIFs being the greatest. Despite this, the rate of ultimate healing is quite high.
Collapse
|
11
|
Hoellwarth JS, Edmonds EW. Difficult Management of a Femur Fracture in a Patient with Dyskeratosis Congenita: A Literature Review and Case Report. JBJS Case Connect 2021; 11:e20.00486. [PMID: 33882034 DOI: 10.2106/jbjs.cc.20.00486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 14-year-old boy with dyskeratosis congenita (DKC), status-post unrelated bone marrow transplant (BMT), sustained a femoral shaft fracture. Despite immediate fixation with the widest possible titanium elastic nails, fixation construct rigidity was insufficient and malunion occurred with refracture 5 years later. Revision fixation with rigid intramedullary nailing has maintained position for 1 year, although callus formation remains meager. CONCLUSION This is the first article to detail fracture care for a DKC patient. Although BMT increases lifespan, patients seemingly remain skeletally frail. Rigid intramedullary fixation is optimally durable and appears hematopoietically safe. Long-term follow-up is recommended.
Collapse
Affiliation(s)
- Jason Shih Hoellwarth
- Baylor College of Medicine, Department of Pediatric Orthopaedics, Texas Children's Hospital, Houston, Texas
| | - Eric W Edmonds
- Rady Children's Hospital San Diego, Division of Orthopaedic Surgery, San Diego, California
| |
Collapse
|
12
|
Lenz M, Acklin YP, Kasper LA, Mischler D, Varga P, Zderic I, Gehweiler D, Klos K, Gueorguiev B, Stoffel K. Biomechanical evaluation of the docking nail concept in periprosthetic fracture fixation around a stemmed total knee arthroplasty. J Biomech 2020; 115:110109. [PMID: 33257010 DOI: 10.1016/j.jbiomech.2020.110109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/02/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Abstract
Intramedullary femoral nails provide an ideal mechanical axis for periprosthetic fracture fixation. Slotted nails allow a connection to a total knee arthroplasty (TKA) stem. This study aims to compare implant and construct stiffness, interfragmentary movement and cycles to failure between an antegrade slotted femoral nail construct docked to a TKA stem and a distal femoral locking plate in a human periprosthetic femoral fracture model. In eight pairs of fresh-frozen human femora with stalked TKA, a 10 mm transverse osteotomy gap was set simulating a Rorabeck type II, Su type I fracture. The femora were pairwise instrumented with either an antegrade slotted nail coupled to the prosthesis stem, or a locking plate. Cyclic testing with a progressively increasing physiologic loading profile was performed at 2 Hz until catastrophic construct failure. Relative movement at the osteotomy site was monitored by means of optical motion tracking. In addition, four-point bending implant stiffness, torsional implant stiffness and frictional fit of the stem-nail connection were investigated via separate non-destructive tests. Intramedullary nails exhibited significantly higher four-point bending and significantly lower torsional implant stiffness than plates, P < 0.01. Increasing difference between nail and stem diameters decreased frictional fit at the stem-nail junction. Nail constructs provided significantly higher initial axial bending stiffness and cycles to failure (200 ± 83 N/mm; 16'871 ± 5'227) compared to plate constructs (93 ± 35 N/mm; 7'562 ± 1'064), P = 0.01. Relative axial translation at osteotomy level after 2'500 cycles was significantly smaller for nail fixation (0.14 ± 0.11 mm) compared with plate fixation (0.99 ± 0.20 mm), P < 0.01. From a biomechanical perspective, the docking nail concept offers higher initial and secondary stability under dynamic axial loading versus plating in TKA periprosthetic fracture fixation.
Collapse
Affiliation(s)
- Mark Lenz
- AO Research Institute Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany.
| | | | - Lena Anna Kasper
- AO Research Institute Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Germany.
| | | | | | | | | | - Kajetan Klos
- Gelenkzentrum Rhein-Main, Hochheim (Main), Germany.
| | | | | |
Collapse
|
13
|
Meshay IM, Martin JR, Auran RL, Jones CB. Proximal Femur Peri-Implant Fracture After Lateral Femur Locking Plate: A Report of 2 Cases. JBJS Case Connect 2020; 10:e1900622-6. [PMID: 32668138 DOI: 10.2106/jbjs.cc.19.00622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE This case report discusses 2 cases of proximal femur peri-implant fractures after the use of lateral locking plates for distal femur periprosthetic fractures. CONCLUSION The use of locking plate technology for fixation of distal femur periprosthetic fractures is a common treatment modality. Although much has been reported regarding healing and complication rates of distal femoral periprosthetic fractures, little has been reported about peri-implant fractures subsequent to treatment using locking plates. We propose the importance of developing a method of fixation to protect the entire femur in osteoporotic patients sustaining distal femur periprosthetic fractures at the index surgery to avoid this complication.
Collapse
Affiliation(s)
- Ian M Meshay
- 1University of Arizona College of Medicine-Phoenix, Phoenix, Arizona 2Department of Orthopaedic Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona 3The CORE Institute, Phoenix, Arizona
| | | | | | | |
Collapse
|
14
|
Nozaka K, Miyakoshi N, Hongo M, Kasukawa Y, Saito H, Kijima H, Tsuchie H, Mita M, Shimada Y. Effectiveness of circular external fixator in periprosthetic fractures around the knee. BMC Musculoskelet Disord 2020; 21:317. [PMID: 32438922 PMCID: PMC7243335 DOI: 10.1186/s12891-020-03352-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/18/2020] [Indexed: 01/27/2023] Open
Abstract
Background The incidence of periprosthetic fractures after total joint arthroplasty (TJA) is rising due to an increasing number of TJAs performed annually and the growing elderly population. In many elderly patients with periprosthetic fractures, the bone strength is lowered due to the deterioration of bone quality and a decrease in bone quantity; rigid fixation of the fracture is difficult. It is a challenging operation for orthopedic surgeons. The usefulness of circular external fixation for periprosthetic fractures has been reported in several case studies. The aim of this study was to investigate the rate of union and complications associated with circular external fixation in periprosthetic fractures around the knee. Methods We included 19 patients with periprosthetic femur and tibial fractures who underwent osteosynthesis using a circular external fixator and had at least 2 years of follow-up. All patients had comorbidities and high risks associated with anesthesia. Tourniquets were not used in any of the patients. There were no cases in which the skin incision was placed, and the closed reduction technique was used in all cases. Results A 100% union rate was achieved with no serious complications. All fractures healed after a mean time of 14.3 ± 5.2 weeks (range, 8–38 weeks). The walking ability was the same level as before the injury in 13 cases. Discussion There are many comorbidities associated with periprosthetic fractures in elderly patients. Double-plate or revision surgery were largely invasive and had high risks associated with anesthesia. Circular external fixation is a feasible and effective treatment option because it provides stable fixation, prompt postoperative mobilization, and has no major complications, especially in elderly patients who are treated for periprosthetic fractures. Conclusion Circular external fixation is a safe and reliable method for periprosthetic fractures around the knee in elderly patients. Level of evidence Level IV, retrospective case series.
Collapse
Affiliation(s)
- Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Hidetomo Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Hiroyuki Tsuchie
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Motoki Mita
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| |
Collapse
|
15
|
Canton G, Giraldi G, Dussi M, Ratti C, Murena L. Osteoporotic distal femur fractures in the elderly: peculiarities and treatment strategies. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:25-32. [PMID: 31821280 PMCID: PMC7233703 DOI: 10.23750/abm.v90i12-s.8958] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 10/25/2019] [Indexed: 11/23/2022]
Abstract
Distal femur fractures account for 4-6% of osteoporosis related fractures of the femur in the elderly population. They represent a relevant cause of morbidity and mortality in the geriatric population with a reported 1-year mortality reaching 30%. Non-displaced fractures or even displaced fractures in patients with high operative risk can be treated conservatively. However, operative treatment is the most widely accepted management option for displaced fractures. The advantage resides in early mobilization and weight-bearing, reducing risks related with a prolonged immobilization when compared with conservative treatment. On the other hand, the intrinsic difficulty of fixing an osteoporotic bone is a major concern. The presence of osteosynthesis devices or prosthetic implants in the femur can make the surgical treatment more challenging, sometimes limiting therapeutic options. Aim of the present paper is to review the most recent literature about osteoporotic distal femur fractures in the elderly, including periprosthetic and other hardware related fractures, to highlight current evidence on management options and related results as a guide for the daily clinical practice.
Collapse
Affiliation(s)
- Gianluca Canton
- Orthopaedics and Traumatology Unit, Cattinara Hospital, Department of Medical, Surgical and Life Sciences, Trieste University, Trieste, Italy..
| | | | | | | | | |
Collapse
|
16
|
Ma CH, Chiu YC, Wu CH, Tsai KL, Wen TK, Jou IM, Tu YK. Plate-on-plate technique for treating peri-implant fractures of distal femoral locking plate: a retrospective study of 11 patients. Arch Orthop Trauma Surg 2019; 139:1245-1251. [PMID: 31037464 DOI: 10.1007/s00402-019-03185-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In this study, we aimed to ascertain the feasibility and reliability of the plate-on-plate technique for peri-implant fractures of the distal femoral locking plate when the distal femoral fracture is still unhealed. MATERIALS AND METHODS From January 2007 to December 2016, we enrolled 11 patients who received treatment at our institution. All patients underwent at least 1 year of follow-up. Their medical records, imaging studies, visual analogue scores, walking ability, complications, and functional outcomes at 1 year postoperative based on the Short Form (36) Health Survey (SF-36) scores were retrospectively evaluated. RESULTS The average follow-up duration was 20.5 (range 15-30) months. All fractures united with satisfactory alignment, and the average time for union was 27.5 (range 16-40) weeks. The average SF-36 scores at 1 year postoperative was 79.2 (range 72-90). Regarding ambulatory status, all patients could perform unrestricted outdoor ambulation. CONCLUSION In our case series, the plate-on-plate technique achieved a good bone union rate and functional outcomes with low complication rates and thus may be a good alternative for managing this difficult type of fracture.
Collapse
Affiliation(s)
- Ching-Hou Ma
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung, Taiwan, ROC
| | - Yen-Chun Chiu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung, Taiwan, ROC
| | - Chin-Hsien Wu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung, Taiwan, ROC
| | - Kun-Ling Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsung-Kai Wen
- Department of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Ming Jou
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung, Taiwan, ROC
| | - Yuan-Kun Tu
- Department of Orthopaedic Surgery, E-Da Hospital, I-Shou University, 1, E-Da Road, Jiau-Shu Tsuen, Yan-Chau Shiang, 824, Kaohsiung, Taiwan, ROC.
| |
Collapse
|
17
|
He QF, Sun H, Shu LY, Zhu Y, Xie XT, Zhan Y, Luo CF. Radiographic predictors for bone mineral loss: Cortical thickness and index of the distal femur. Bone Joint Res 2018; 7:468-475. [PMID: 30123496 PMCID: PMC6076359 DOI: 10.1302/2046-3758.77.bjr-2017-0332.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Researchers continue to seek easier ways to evaluate the quality of bone and screen for osteoporosis and osteopenia. Until recently, radiographic images of various parts of the body, except the distal femur, have been reappraised in the light of dual-energy X-ray absorptiometry (DXA) findings. The incidence of osteoporotic fractures around the knee joint in the elderly continues to increase. The aim of this study was to propose two new radiographic parameters of the distal femur for the assessment of bone quality. METHODS Anteroposterior radiographs of the knee and bone mineral density (BMD) and T-scores from DXA scans of 361 healthy patients were prospectively analyzed. The mean cortical bone thickness (CBTavg) and the distal femoral cortex index (DFCI) were the two parameters that were proposed and measured. Intra- and interobserver reliabilities were assessed. Correlations between the BMD and T-score and these parameters were investigated and their value in the diagnosis of osteoporosis and osteopenia was evaluated. RESULTS The DFCI, as a ratio, had higher reliability than the CBTavg. Both showed significant correlation with BMD and T-score. When compared with DFCI, CBTavg showed better correlation and was better for predicting osteoporosis and osteopenia. CONCLUSION The CBTavg and DFCI are simple and reliable screening tools for the prediction of osteoporosis and osteopenia. The CBTavg is more accurate but the DFCI is easier to use in clinical practice.Cite this article: Q-F. He, H. Sun, L-Y. Shu, Y. Zhu, X-T. Xie, Y. Zhan, C-F. Luo. Radiographic predictors for bone mineral loss: Cortical thickness and index of the distal femur. Bone Joint Res 2018;7:468-475. DOI: 10.1302/2046-3758.77.BJR-2017-0332.R1.
Collapse
Affiliation(s)
- Q-F. He
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - H. Sun
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - L-Y. Shu
- Emergency Department, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Y. Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - X-T. Xie
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Y. Zhan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - C-F. Luo
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| |
Collapse
|