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Jadib I, Rachidi HE, Abdennaji S, Messoudi A, Rafai M. A rare combination of sagittal fracture of the medial femoral condyle (Trélat fracture) with an ipsilateral femoral shaft fracture: A case report. Int J Surg Case Rep 2024; 119:109657. [PMID: 38718491 PMCID: PMC11098947 DOI: 10.1016/j.ijscr.2024.109657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/05/2024] [Accepted: 04/19/2024] [Indexed: 05/20/2024] Open
Abstract
INTRODUCTION Isolated unicondylar fractures of the distal femur are rare injuries, accounting for 3-6 % of adult femur fractures. The association with a femoral shaft fracture is very rare and, to our knowledge, has, never been described in the literature. CASE PRESENTATION In this article, we report the case of a 19-year-old motorcyclist involved in an accident, that resulted in both a midshaft transverse femoral fracture and an ipsilateral sagittal fracture of the medial femoral condyle (Trélat fracture). CLINICAL DISCUSSION The surgical intervention involved open reduction and internal fixation for both fractures, utilizing a dynamic compression plate for the femoral shaft fracture and screws for the medial condyle fracture. Postoperative results showed excellent fracture reduction, and the patient progressed well with rehabilitation. The choice of fixation method for the sagittal medial femoral condyle fracture considered the unique anatomical challenges posed by this rare combination, the emergency (fat embolism), and the fact we didn't have a retrograde nail in our structure. A dynamic compression plate was used for femoral shaft fracture and screw fixation for condyle fracture treatment. The traction table in anterograde femoral nailing, led to the recurvatum of the condylar fracture and difficulty accessing it with the medial subvastus approach. CONCLUSION This case report adds a description of a rare combination and valuable insight into the management of complex femoral fractures, emphasizing the importance of individualized treatment approaches.
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Affiliation(s)
- Imad Jadib
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco.
| | - Houssam Eddine Rachidi
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
| | - Soufiane Abdennaji
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
| | - Abdeljebbar Messoudi
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
| | - Mohamed Rafai
- Department of Orthopedics and Trauma-Surgery P32, University Hospital Center IBN Rochd - Casablanca, Faculty of Medicine and Pharmacy Hassan-II, Morocco
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Wang AWT, Stockton DJ, Flury A, Kim TG, Roffey DM, Lefaivre KA. Radiographic Union Assessment in Surgically Treated Distal Femur Fractures: A Systematic Review. JBJS Rev 2024; 12:01874474-202403000-00001. [PMID: 38446912 DOI: 10.2106/jbjs.rvw.23.00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Distal femur fractures are known to have challenging nonunion rates. Despite various available treatment methods aimed to improve union, optimal interventions are yet to be determined. Importantly, there remains no standard agreement on what defines radiographic union. Although various proposed criteria of defining radiographic union exist in the literature, there is no clear consensus on which criteria provide the most precise measurement. The use of inconsistent measures of fracture healing between studies can be problematic and limits their generalizability. Therefore, this systematic review aims to identify how fracture union is defined based on radiographic parameters for surgically treated distal femur fractures in current literature. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection databases were searched from inception to October 2022. Studies that addressed surgically treated distal femur fractures with reported radiographic union assessment were included. Outcomes extracted included radiographic definition of union; any testing of validity, reliability, or responsiveness; reported union rate; reported time to fracture union; and any functional outcomes correlated with radiographic union. RESULTS Sixty articles with 3,050 operatively treated distal femur fractures were included. Operative interventions included lateral locked plate (42 studies), intramedullary nail (15 studies), dynamic condylar screw or blade plate (7 studies), dual plate or plate and nail construct (5 studies), distal anterior-posterior/posterior-anterior screws (1 study), and external fixation with a circular frame (1 study). The range of mean follow-up time reported was 4.3 to 44 months. The most common definitions of fracture union included "bridging or callus formation across 3 of 4 cortices" in 26 (43%) studies, "bony bridging of cortices" in 21 (35%) studies, and "complete bridging of cortices" in 9 (15%) studies. Two studies included additional assessment of radiographic union using the Radiographic Union Scale in Tibial fracture (RUST) or modified Radiographic Union Scale in Tibial fracture (mRUST) scores. One study included description of validity, and the other study included reliability testing. The reported mean union rate of distal femur fractures was 89% (range 58%-100%). The mean time to fracture union was documented in 49 studies and found to be 18 weeks (range 12-36 weeks) in 2,441 cases. No studies reported correlations between functional outcomes and radiographic parameters. CONCLUSION The current literature evaluating surgically treated distal femur fractures lacks consistent definition of radiographic fracture union, and the appropriate time point to make this judgement is unclear. To advance surgical optimization, it is necessary that future research uses validated, reliable, and continuous measures of radiographic bone healing and correlation with functional outcomes. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alice Wei Ting Wang
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David J Stockton
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Andreas Flury
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Taylor G Kim
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Darren M Roffey
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kelly A Lefaivre
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Orthopaedic Trauma, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Wu J, Chen Y, Zhu Y, Wu X, Ren P, Cao F. Clinical efficacy of internal fixation with locking compression plates in the treatment of patients with extremity fractures and the effect on the recovery of limb function. Medicine (Baltimore) 2023; 102:e35884. [PMID: 38050232 PMCID: PMC10695631 DOI: 10.1097/md.0000000000035884] [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: 07/11/2023] [Accepted: 10/11/2023] [Indexed: 12/06/2023] Open
Abstract
The purpose of this study was to evaluate the clinical efficacy of internal fixation with locking compression plates (LCP) in the treatment of patients with extremity fractures and the effect on the recovery of limb function. A total of 488 patients with extremity fractures admitted to our hospital from June 2019 to December 2022 were retrospectively analyzed and divided into open reduction and internal fixation (ORIF) group (n = 236) and internal fixation with LCP group (n = 252) according to the surgical procedure. Outcome indicators included intraoperative bleeding, operative time, length of hospital stay, pain duration, quality of life, healing time of the fracture, postoperative complications, and restoration of limb function as per the X-ray examination results and Johner-Wruhs criteria. Self-rating Depression Scale and Self-rating Anxiety Scale were used to evaluate the changes of patients' negative emotions before and after treatment. LCP group was associated with significantly less intraoperative bleeding and shorter operative time, length of hospital stays, and pain duration compared with ORIF group (P < .05). Compared with ORIF group, LCP group provided more rapid fracture healing in tibial fractures, ulnar fractures, radial fractures, and external ankle fractures (P < .05). Compared with the ORIF group, patients in the LCP group showed better quality of life in terms of physical, psychological and social functions after surgery (P < .05). The incidence of postoperative complications in the LCP group was significantly lower than that in the ORIF group (19.92% vs 7.14%, P < .001). The Self-rating Depression Scale and Self-rating Anxiety Scale scores of the LCP group were lower than those of the ORIF group (P < .05). The recovery of limb function was significantly better in the LCP group than in the ORIF group (97.22% vs 85.17%, P < .001). The overall satisfaction rate of treatment in the LCP group was higher than that in the ORIF group (92.06% vs 81.90%, P < .001). Internal fixation with LCP in patients with extremity fractures can effectively promote the recovery of limb function, reduce the incidence of complications and improve the quality of life of patients.
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Affiliation(s)
- Jun Wu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Yang Chen
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Yin Zhu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Xiaodong Wu
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Pengpeng Ren
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
| | - Feng Cao
- Department of Orthopedics, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, China
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Liu J, Huang Z, Qi Y, Long Y, Zhang Y, Liu N, Zuo G, Wang W. Biomechanical analysis of bridge combined fixation system as a novel treatment for the fixation of type A3 distal femoral fractures. Front Surg 2023; 10:1264904. [PMID: 38033528 PMCID: PMC10687203 DOI: 10.3389/fsurg.2023.1264904] [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: 07/21/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background To compare the biomechanical parameters of AO/OTA type A3 distal femoral fractures fixed bilaterally with a bridge combined fixation system (BCFS) and lateral locking compression plate + locking reconstruction plate (LCP + LRP). Methods Twelve A3 distal femoral fracture models with medial cortical defects of the distal femur were created using synthetic femoral Sawbones. BCFS and LCP + LRP were used for bilateral fixation, with six in each group. Axial compression and torsion tests were performed on the two groups of fracture models to determine their stiffness during axial compression and the Torsional stiffness during torsion tests. Axial compression failure tests were performed to collect the vertical loads of the ultimate failure tests. Results In the test conducted on the fixed type A3 distal femoral fracture models, the axial stiffness in the BCFS group (group A) (1,072.61 ± 113.5 N/mm) was not significantly different from that in the LCP + LRP group (group B) (1,184.13 ± 110.24 N/mm) (t = 1.726, P = 0.115), the Torsional stiffness in group A (3.73 ± 0.12 N.m/deg) was higher than that in group B (3.37 ± 0.04 N.m/deg) (t = 6.825, P < 0.001),and the ultimate failure test of type A3 fracture model showed that the vertical load to destroy group A fixation (5,290.45 ± 109.63 N) was higher than that for group B (3,978.43 ± 17.1 N) (t = 23.28, P < 0.05). Notably, intertrochanteric fractures occurred in groups A and B. Conclusions In the fixation of type A3 distal femoral fractures, the anti-axial compression of the BCFS group was similar to that of the LCP + LRP group, but the anti-torsion was better.
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Affiliation(s)
- Jianke Liu
- Shandong First Medical University & Shandong Academy Medical Sciences, Jinan, China
| | - Zhaozhao Huang
- Tianjin Walkman Biomaterial Co., Ltd. Newton Laboratory, Tianjin, China
| | - Yubin Qi
- Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yuntao Long
- Shandong First Medical University & Shandong Academy Medical Sciences, Jinan, China
| | - Yanhui Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Na Liu
- Tianjin Walkman Biomaterial Co., Ltd. Newton Laboratory, Tianjin, China
| | - Guilai Zuo
- Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Wen Wang
- Department of Orthopaedics, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Sainio H, Rämö L, Reito A, Silvasti-Lundell M, Lindahl J. Prediction of fracture nonunion leading to secondary surgery in patients with distal femur fractures. Bone Jt Open 2023; 4:584-593. [PMID: 37580052 PMCID: PMC10425244 DOI: 10.1302/2633-1462.48.bjo-2023-0077.r1] [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] [Indexed: 08/16/2023] Open
Abstract
Aims Several previously identified patient-, injury-, and treatment-related factors are associated with the development of nonunion in distal femur fractures. However, the predictive value of these factors is not well defined. We aimed to assess the predictive ability of previously identified risk factors in the development of nonunion leading to secondary surgery in distal femur fractures. Methods We conducted a retrospective cohort study of adult patients with traumatic distal femur fracture treated with lateral locking plate between 2009 and 2018. The patients who underwent secondary surgery due to fracture healing problem or plate failure were considered having nonunion. Background knowledge of risk factors of distal femur fracture nonunion based on previous literature was used to form an initial set of variables. A logistic regression model was used with previously identified patient- and injury-related variables (age, sex, BMI, diabetes, smoking, periprosthetic fracture, open fracture, trauma energy, fracture zone length, fracture comminution, medial side comminution) in the first analysis and with treatment-related variables (different surgeon-controlled factors, e.g. plate length, screw placement, and proximal fixation) in the second analysis to predict the nonunion leading to secondary surgery in distal femur fractures. Results We were able to include 299 fractures in 291 patients. Altogether, 31/299 fractures (10%) developed nonunion. In the first analysis, pseudo-R2 was 0.27 and area under the receiver operating characteristic curve (AUC) was 0.81. BMI was the most important variable in the prediction. In the second analysis, pseudo-R2 was 0.06 and AUC was 0.67. Plate length was the most important variable in the prediction. Conclusion The model including patient- and injury-related factors had moderate fit and predictive ability in the prediction of distal femur fracture nonunion leading to secondary surgery. BMI was the most important variable in prediction of nonunion. Surgeon-controlled factors had a minor role in prediction of nonunion.
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Affiliation(s)
- Heini Sainio
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aleksi Reito
- Centre for Musculoskeletal Diseases, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Marja Silvasti-Lundell
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jan Lindahl
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Haase DR, Haase LR, Moon TJ, Dallman J, Vance D, Benedick A, Ochenjele G, Napora JK, Wise BT. Perioperative allogenic blood transfusions are associated with increased fracture related infection rates, but not nonunion in operatively treated distal femur fractures. Injury 2023:S0020-1383(23)00383-2. [PMID: 37188588 DOI: 10.1016/j.injury.2023.04.041] [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: 12/03/2022] [Revised: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Distal femur fractures are common injuries that remain difficult for orthopedic surgeons to treat. High complication rates, including nonunion rates as high as 24% and infection rates of 8%, can lead to increased morbidity for these patients. Allogenic blood transfusions have previously been identified as risk factors for infection in total joint arthroplasty and spinal fusion surgeries. No studies have explored the relationship between blood transfusions and fracture related infection (FRI) or nonunion in distal femur fractures. METHODS 418 patients with operatively treated distal femur fractures at two level I trauma centers were retrospectively reviewed. Patient demographics were collected including age, gender, BMI, medical comorbidities, and smoking. Injury and treatment information was also collected including open fracture, polytrauma status, implant, perioperative transfusions, FRI, and nonunion. Patients with less than three months of follow up were excluded. RESULTS 366 patients were included in final analysis. One hundred thirty-nine (38%) patients received a perioperative blood transfusion. Forty-seven (13%) nonunions and 30 (8%) FRI were identified. Allogenic blood transfusion was not associated with nonunion (13% vs 12%, P = 0.87), but was associated with FRI (15% vs 4%, P<0.001). Binary logistic regression analysis identified a dose dependent relationship between number of perioperative blood transfusions and FRI: total transfusion ≥2 U PRBC RR= 3.47(1.29, 8.10, P = 0.02), ≥3 RR= 6.99 (3.01, 12.40, P<0.001), and ≥4 RR= 8.94 (4.03, 14.42, P<0.001). DISCUSSION In patients undergoing operative treatment of distal femur fractures, perioperative blood transfusions are associated with increased risk of fracture related infection, but not the development of a nonunion. This risk association increases in a dose-dependent relationship with increasing total blood transfusions received.
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Failure analysis of a locking compression plate with asymmetric holes and polyaxial screws. J Mech Behav Biomed Mater 2023; 138:105645. [PMID: 36603526 DOI: 10.1016/j.jmbbm.2022.105645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/27/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022]
Abstract
Locking compression plates (LCP) with asymmetrical holes and polyaxial screws are effective for treating mid-femoral fractures, but are prone to failure in cases of bone nonunion. To understand the failure mechanism of the LCP, this study assessed the material composition, microhardness, metallography, fractography and biomechanical performance of a retrieved LCP used for treating a bone fracture of AO type 32-A1. For the biomechanical assessment, a finite element surgical model implanted with the intact fixation-plate system was constructed to understand the stresses and structural stiffness on the construct. Also, to avoid positioning screws around the bone fracture, different working lengths of the plate (the distance between the two innermost screws) and screw inclinations (±5°, ±10° and ±15°) were investigated. The fracture site of the retrieved LCP was divided into a narrow side and broad side due to the asymmetrical distribution of holes on the plate. The results indicated that the chemical composition and microhardness of the LCP complied with ASTM standards. The fatigue failure was found to originate on the narrow side of the hole, while the broad side showed overloading characteristics of crack growth. When the screws were inserted away from the region of the bone fracture by increasing the working length, the stress of the fixation-plate system decreased. Regardless of the screw insertion angle, the maximum stress on the LCP always appeared on the narrow side, and there was little change in the structural stiffness. However, angling the screws at -10° resulted in the most even stress distribution on the fixation-plate system. In conclusion, the LCP assessed in this study failed by fatigue fracture due to bone nonunion and stress concentration. The narrow side of the LCP was vulnerable to failure and needs to be strengthened. When treating an AO type 32-A1 fracture using an LCP with asymmetrical holes and polyaxial screws, inserting the screws at -10° may reduce the risk of implant failure and positing screws around the fractured area of the bone should be avoided.
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Rosell-Pradas J, Redondo-Trasobares B, Sarasa-Roca M, Albareda-Albareda J, Puértolas-Broto S, Herrera-Rodríguez A, Gracia-Villa L. Influence of plate size and screw distribution on the biomechanical behaviour of osteosynthesis by means of lateral plates in femoral fractures. Injury 2023; 54:395-404. [PMID: 36528423 DOI: 10.1016/j.injury.2022.12.003] [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: 11/09/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Distal femoral fractures are fractures associated with high rates of morbidity and mortality, affecting to three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. They have been classically treated with conventional plates and intramedullary nails and more recently with locked plates that have increased their indications to more types of fractures. The main objective of the present work is the biomechanical study, by means of finite element simulation, of the stability achieved in the osteosynthesis of femoral fractures in zones 4 and 5 of Wiss, by using locked plates with different plate lengths and different screw configurations, and analysing the effect of screw proximity to the fracture site. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by Osteosynthesis System LOQTEC® Lateral Distal Femur Plate in two different fracture zones corresponding to the zones 4 and 5 according to the Wiss fracture classification. The study was focused on the immediately post-operative stage, without any biological healing process. The obtained results show that more stable osteosyntheses were obtained by using shorter plates. In the cases of longer plates, it results more convenient disposing screws in a way that the upper ones are closer to fracture site. The obtained results can support surgeons to understand the biomechanics of fracture stability, and then to guide them towards the more appropriate osteosynthesis depending on the fracture type and location.
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Affiliation(s)
- J Rosell-Pradas
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - B Redondo-Trasobares
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - M Sarasa-Roca
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - J Albareda-Albareda
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain; Department of Surgery, University of Zaragoza, Zaragoza, Spain.
| | - S Puértolas-Broto
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
| | | | - L Gracia-Villa
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
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Muacevic A, Adler JR. Plating for Intra-articular Fractures of the Distal Femur: Functional and Radiological Outcomes. Cureus 2023; 15:e33207. [PMID: 36733563 PMCID: PMC9887661 DOI: 10.7759/cureus.33207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/03/2023] Open
Abstract
Background and objective Intra-articular fractures of the distal femur pose a significant surgical difficulty. These fractures are challenging to repair, and surgery is frequently advised for a successful outcome. The distal femoral fractures make up between 4-6% of all femoral fractures and account for less than 1% of all fractures. When compared to the single screw's axial stiffness or pullout resistance, as is the case with unlocked plates, the locking compression plate (LCP) is a single beam construct whose strength of fixation is equal to the sum of all screw-bone contacts. Against this backdrop, the current study was conducted for evaluating the functional outcomes of distal femoral fractures treated with LCP fixation. Methodology We conducted an observational study at a tertiary care facility in Kolar spanning a period of three years, from January 2019 to January 2022. We included all patients aged more than 18 years, who were diagnosed with distal femoral fractures [only those classified as type C according to the AO Foundation/Orthopedic Trauma Association (AO/OTA) classification]. Patients with terminal illnesses, revision of previous surgery, fractures with neurovascular injuries, and those diagnosed with pathological fractures were excluded from the study. The included patients were treated by LCP and discharged on postoperative day 10 after suture removal. The first follow-up was at the first month and subsequent follow-ups were done at three and six months, and the functional outcomes were assessed by using Neer's score for straight leg raises. Radiographs with fading fracture lines and callus formation on three-fourths of the cortices were regarded as indicators of fracture healing. Results Among the 30 study participants, 80% were males. The mean time for the radiological union was 15 weeks. In this study, there were no instances of infection or angular deformity greater than 5 degrees. About 80% of the study participants had ranges of motion (ROM) above 120 degrees at the end of the six-month follow-up period; 12 cases had an excellent score (40%), 15 cases (50%) had a satisfactory score, two cases (6.7%) had an unsatisfactory score, and only one case had poor score. Common complications observed were excessive bleeding, difficulty in reduction, superficial infections, and knee stiffness. Conclusion For patients with distal femoral fractures, the LCP treatment can result in good functional and radiological outcomes with fewer complications.
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Paiva MDM, Leal DP, Kuroki PK, Barroso BG, Reyna MAA, Leonhardt MDC, Silva JDS, Kojima KE. DISTAL FEMORAL FRACTURES FROM HIGH-ENERGY TRAUMA: A RETROSPECTIVE REVIEW OF COMPLICATION RATE AND RISK FACTORS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e256896. [PMID: 36506858 PMCID: PMC9721413 DOI: 10.1590/1413-785220223002e256896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/03/2021] [Indexed: 12/05/2022]
Abstract
Objective Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate. Methods Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034). Conclusion High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture. Level of Evidence III; Retrospective Cohort Study .
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Affiliation(s)
- Micael de Mesquita Paiva
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Daniel Peixoto Leal
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Paulo Ken Kuroki
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Barbara Garcia Barroso
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Marco Antonio Avalos Reyna
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Marcos de Camargo Leonhardt
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Jorge dos Santos Silva
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Kodi Edson Kojima
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Trauma Group, HC-DOT/FMUSP, São Paulo, SP, Brazil
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11
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Total femur fixation using the "nail-plate docking technique" for ipsilateral femur shaft fracture. Trauma Case Rep 2022; 42:100722. [PMID: 36281428 PMCID: PMC9587334 DOI: 10.1016/j.tcr.2022.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/09/2022] Open
Abstract
In an aging society, the number of femoral fractures is increasing, as well as the incidence of periprosthetic fractures. These secondary fractures are often difficult to fixate stably because of the osteoporotic bone and the existence of the former implant. Herein, we present two cases of secondary femoral shaft fractures after osteosyntheses for distal femur fractures with polyaxial locking plates (Non-Contact-Bridging Distal Femur, NCB-DF®, ZimmerBIOMET, Winterthur, Switzerland). Antegrade intramedullary nails (Natural Nail®-GT Femoral, ZimmerBIOMET, Winterthur, Switzerland) were utilized without removal of the NCB-DFs. In these osteosyntheses, proximal locking screws of NCB-DFs were inserted and locked into the distal inter-locking holes of Natural Nails. This "nail-plate docking technique" could allow for more stable fixation of the whole femur with minimally invasive surgical intervention while preserving the existing implant. Although there are a few surgical technical knacks and pitfalls in inserting the screw, further fractures of the femur could also be prevented with this technique.
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12
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Grisdela P, Striano B, Shapira S, Heng M. Does distance from joint line influence complications after distal femur fractures in native and periprosthetic knees? Knee 2022; 37:80-86. [PMID: 35700587 DOI: 10.1016/j.knee.2022.05.012] [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: 04/29/2021] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Distal femur fractures are projected to increase in incidence secondary to an aging population and growing utilization of total knee arthroplasty. Surgical management is the standard of care, but optimal treatment for far distal fractures is still unclear. Our study investigates if there are distal femur fractures too distal to be treated with lateral locked plating in periprosthetic fractures. METHODS One hundred and ten consecutive patients treated with locked plating for distal femur fractures around a total knee replacement were identified using CPT codes. Fractures were classified by length of the distal fracture segment and Su classification. Complications studied were nonunion, malunion, infection, further fracture related surgery, readmission within 90 days, and mortality within 1 year of surgery. Sixty six fractures met inclusion criteria of 180 days of follow-up or sustaining a complication prior to180 days. RESULTS The size of the distal fracture segment and Su classification did not correlate with increased complication rate in periprosthetic distal femur fractures. CONCLUSIONS There was no difference between complications following lateral locked plating of distal femur fractures based on the size of the distal fracture segment in periprosthetic fractures. Lateral locked plating is an effective treatment modality for these fractures regardless of how distal the fracture extends.
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Affiliation(s)
- Phillip Grisdela
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
| | - Brendan Striano
- Harvard Combined Orthopaedic Residency Program, Boston, MA, USA.
| | - Shay Shapira
- Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba, Israel; Harvard Medical School Orthopaedic Trauma Initiative, Boston MA, USA.
| | - Marilyn Heng
- Harvard Medical School Orthopaedic Trauma Initiative, Boston MA, USA; Massachusetts General Hospital, Department of Orthopaedic Surgery, Boston, MA, USA.
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13
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Paulsson M, Ekholm C, Jonsson E, Geijer M, Rolfson O. Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial. Geriatr Orthop Surg Rehabil 2022; 12:21514593211055889. [PMID: 35145761 PMCID: PMC8822340 DOI: 10.1177/21514593211055889] [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] [Indexed: 11/15/2022] Open
Abstract
Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.
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Affiliation(s)
- Martin Paulsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Ekholm
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eythor Jonsson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mats Geijer
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ola Rolfson
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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14
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史 金, 肖 玉. [Current status and progress of locking plate in the treatment of distal femoral comminuted fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1352-1356. [PMID: 34651492 PMCID: PMC8505932 DOI: 10.7507/1002-1892.202102050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/27/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review the current status and progress of locking plate for the treatment of distal femoral comminuted fractures. METHODS The related literature was extensively reviewed to summarize the current status and progress in the treatment of distal femoral comminuted fracture with locking plate from four aspects: the current treatment situation, the shortcomings of locking plate and countermeasures, the progress of locking technology, locking plate and digital orthopedic technology. RESULTS Treatment of distal femoral comminuted fractures is challenging. Locking plates, the most commonly used fixation for distal femoral comminuted fractures, still face a high rate of treatment failure. Double plates can improve the mechanical stability of comminuted fractures, but specific quantitative criteria are still lacking for when to choose double plates for fixation. The far cortial locking screw has shown good application value in improving the micro-movement and promoting the growth of callus. The biphasic plating is a development of the traditional locking plate, but needs further clinical examination. As an auxiliary means, digital orthopedic technology shows a good application prospect. CONCLUSION The inherent defect of locking plate is a factor that affects the prognosis of distal femoral comminuted fracture. The optimization of locking technology combined with digital orthopedic technology is expected to reduce the failure rate of treatment of distal femoral comminuted fracture.
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Affiliation(s)
- 金友 史
- 蚌埠医学院第一附属医院骨科(安徽蚌埠 233000)Department of Orthopedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - 玉周 肖
- 蚌埠医学院第一附属医院骨科(安徽蚌埠 233000)Department of Orthopedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
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15
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Shi J, Xiao Y, Wu M, Guan J. [Research on the nature of micromovement and the biomechanical staging of fracture healing]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1205-1211. [PMID: 34523290 DOI: 10.7507/1002-1892.202103050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the nature of micromovement and the biomechanical staging of fracture healing. Methods Through literature review and theoretical analysis, the difference in micromovement research was taken as the breakthrough point to try to provide a new understanding of the role of micromovement and the mechanical working mode in the process of fracture healing. Results The process of fracture healing is the process of callus generation and connection. The micromovement is the key to start the growth of callus, and the total amount of callus should be matched with the size of the fracture space. The strain at the fracture end is the key to determine the callus connection. The strain that can be tolerated by different tissues in the fracture healing process will limit the micromovement. According to this, the fracture healing process can be divided into the initiation period, perfusion period, contradiction period, connection period, and physiological period, i.e., the biomechanical staging of fracture healing. Conclusion Biomechanical staging of fracture healing incorporates important mechanical parameters affecting fracture healing and introduces the concepts of time and space, which helps to understand the role of biomechanics, and its significance needs further clinical test and exploration.
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Affiliation(s)
- Jinyou Shi
- Department of Orthopaedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - Yuzhou Xiao
- Department of Orthopaedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - Min Wu
- Department of Orthopaedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
| | - Jianzhong Guan
- Department of Orthopaedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China
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16
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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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17
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Alcântara B, Minto B, Franco G, Lucena D, Dias L. Bridge plating for simple tibial fractures treated by minimally invasive plate osteosynthesis. ARQ BRAS MED VET ZOO 2021. [DOI: 10.1590/1678-4162-12261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.
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Affiliation(s)
| | | | - G.G. Franco
- Universidade Federal do Espírito Santo, Brazil
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18
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Pogliacomi F, Artoni C, Calderazzi F, Leigheb M, Primiceri P, Pedrazzini A, Ceccarelli F, Vaienti E. Distal femur nonunion treated with retrograde intramedullary nailing and RIA: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:259-266. [PMID: 32555107 PMCID: PMC7944819 DOI: 10.23750/abm.v91i4-s.9656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Indexed: 11/23/2022]
Abstract
The current treatment of distal femur fractures includes locking plating and retrograde intramedullary nailing. These fractures are difficult to manage also for experienced surgeons, with results not always satisfactory. Reported nonunion rates now range from 0 to 34%. Factors associated with nonunion include comorbidities, such as obesity and diabetes, as well as the presence of open fractures, medial bone defects and comminuted fractures. This case report summarizes all of these assumptions and it concerns a 58 years old patient who underwent to 6 surgical procedures before to arrive to bone healing. (www.actabiomedica.it)
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Affiliation(s)
- Francesco Pogliacomi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Carlotta Artoni
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Filippo Calderazzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Massimiliano Leigheb
- Orthopaedics and Traumatology Unit, "Maggiore della Carità" Hospital, Università del Piemonte Orientale (UPO), Corso Mazzini 18, 28100 Novara (Italy).
| | - Paolo Primiceri
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | | | - Francesco Ceccarelli
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Enrico Vaienti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
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Kodama H, Saku I, Tomoyama S. Surgical treatment of femoral medial condyle fracture with lag screws and proximal tibial plate: A case report. Int J Surg Case Rep 2020; 70:101-105. [PMID: 32416477 PMCID: PMC7226634 DOI: 10.1016/j.ijscr.2020.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
This is a case of medial femoral condyle fracture, an extremely rare fracture. Operation was performed with a proximal tibial plate; this is a novel case. The implant fitted well to the bone surface. This implant could be a treatment option for this fracture in other cases.
Introduction Femoral medial condyle fracture is a rare fracture. Here, we report a case of femoral medial condyle fracture treated with lag screws and proximal tibial plate as a buttress plate. Case presentation A 80-year-old woman fell down 15 steps at her home and reported to our hospital with severe right knee pain. Radiographs and computed tomography demonstrated a femoral medial condyle fracture in the right knee (AO classification: 33-B2). Two days after injury, we performed open reduction and internal fixation using locking compression plate for proximal tibia and screws. The patient had an uneventful postoperative recovery. At the latest follow-up, the patient achieved a range of motion of 0° to 120° and could walk without pain. Discussion Femoral medial condyle fracture is a rare fracture. As with any articular injury, anatomical restoration of the joint surface must be obtained, then lag screw fixation is required. In fractures with a vertical fracture line, a buttress plate is necessary to counteract the vertical shear forces. Nevertheless, there are no available anatomical plates that fit either the femoral medial condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. We used a locking compression plate - proximal tibial plate 4.5/5.0 (Depuy Synthes TRAUMA) as a buttress plate. The implant fitted well and enhanced joint stability. Postoperative radiographs confirmed anatomical reduction, and the patient achieved a good result. Conclusion The locking compression plate for proximal tibia is an acceptable solution for femoral medial condyle fracture.
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Affiliation(s)
- Hiroyasu Kodama
- Department of Orthopaedic Surgery, Yaizu City Hospital, Shizuoka, Japan.
| | - Isaku Saku
- Department of Orthopaedic Surgery, Yaizu City Hospital, Shizuoka, Japan.
| | - Shin Tomoyama
- Department of Orthopaedic Surgery, Yaizu City Hospital, Shizuoka, Japan.
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