Ricci William M, Loftus Timothy, Cox Christopher, Borrelli Joseph
Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
J Orthop Trauma. 2006 Mar;20(3):190-6. doi: 10.1097/00005131-200603000-00005.
New locked plate devices offer theoretical advantages for the treatment of supracondylar femur fractures associated with a total knee arthroplasty (TKA). These devices also can be inserted with relative ease by using minimally invasive techniques, provide a fixed angle construct, and improve fixation in osteoporotic bone. The purpose of this study was to evaluate the results and complications of treating periprosthetic supracondylar femur fractures above a TKA with a locked plate designed for the distal femur.
Prospective, consecutive case series.
Level I trauma center.
PATIENTS/PARTICIPANTS: Twenty-two consecutive adult patients with 24 (2 bilateral) supracondylar femur fractures (OTA 33A) above a well-fixed non-stemmed TKA were treated with the Locking Condylar Plate. One patient who died before fracture healing and 1 who was lost to follow-up were excluded from analysis. All remaining patients (5 males, 15 females, average age, 73 (range, 50-95) years) were available for follow-up at an average of 15 (range, 6-45) months. According to the OTA classification, there were three 33A1, eight 33A2, and eleven 33A3 fractures. All fractures were closed. Indirect reduction methods without bone graft were used in all cases.
Nineteen of 22 fractures healed after the index procedure (86%). All 3 patients with healing complications were insulin-dependent patients with diabetes who also were obese (body mass index >30). Two developed infected nonunions and 1 an aseptic nonunion. Postoperative alignment was satisfactory (within 5 degrees ) for 20 of 22 fractures. Fracture of screws in the proximal fragment occurred in 4 patients. In 3 of these cases, there was progressive coronal plane deformity. There was no change in alignment in any other patient. Fifteen of 17 patients who healed returned to their baseline ambulatory status, with 5 requiring additional ambulatory support compared with baseline.
Fixation of periprosthetic supracondylar femur fractures with a locking plate provided satisfactory results in nondiabetic patients. Diabetic patients seem to be at high risk for healing complications and infection.
新型锁定钢板装置在治疗与全膝关节置换术（TKA）相关的股骨髁上骨折方面具有理论优势。这些装置还可通过微创技术相对轻松地插入，提供固定角度结构，并改善骨质疏松骨中的固定。本研究的目的是评估使用专为股骨远端设计的锁定钢板治疗TKA上方假体周围股骨髁上骨折的结果和并发症。
前瞻性连续病例系列。
一级创伤中心。
患者/参与者：22例连续成年患者，其24处（2例双侧）股骨髁上骨折（OTA 33A）发生在固定良好的非骨水泥型TKA上方，采用锁定髁钢板治疗。1例在骨折愈合前死亡的患者和1例失访患者被排除在分析之外。所有其余患者（5例男性，15例女性，平均年龄73岁（范围50 - 95岁））平均随访15个月（范围6 - 45个月）。根据OTA分类，有3例33A1骨折、8例33A2骨折和11例33A3骨折。所有骨折均为闭合性骨折。所有病例均采用不植骨的间接复位方法。
22例骨折中有19例在初次手术后愈合（86%）。所有3例出现愈合并发症的患者均为胰岛素依赖型糖尿病患者，且均肥胖（体重指数>30）。2例发生感染性骨不连，1例发生无菌性骨不连。22例骨折中有20例术后对线满意（在5度以内）。4例患者近端骨折块中的螺钉发生断裂。其中3例出现冠状面渐进性畸形。其他患者的对线无变化。17例愈合患者中有15例恢复到基线活动状态，与基线相比，5例需要额外的行走辅助。
使用锁定钢板固定假体周围股骨髁上骨折在非糖尿病患者中取得了满意的结果。糖尿病患者似乎有较高的愈合并发症和感染风险。
