Department of Orthopaedic Surgery, MetroHealth Medical Center, affiliated with Case Western Reserve University, Cleveland, OH, USA.
J Orthop Trauma. 2012 Jun;26(6):327-32. doi: 10.1097/BOT.0b013e318234d460.
In the distal femur, locked plating is efficacious when coronal fractures preclude the use of a conventional fixed-angle device. However, minimal comparative data exist for supracondylar fracture patterns, which could be treated with other devices. The purpose of this study was to compare the 95-degree angled blade plate (ABP) versus the Locking Condylar Plate (LCP) by assessing complications and secondary procedures in fractures amenable to treatment with either implant.
Retrospective review.
Level 1 trauma center.
PATIENTS/PARTICIPANTS: Seventy patients with 71 distal femoral fractures (OTA 33-A, 33-C1, 33-C2) amenable to either ABP or LCP with a mean age of 59.5 years (range, 20-92 years) were included. Seventeen fractures (24%) occurred adjacent to a previous knee arthroplasty (10 ABP and 7 LCP). The 2 groups were similar with respect to age, fracture pattern, and the presence of open fracture. Most injuries were the result of high-energy trauma, and 21% were open fractures.
Thirty-two fractures (45%) were treated with an ABP, and 39 (55%) were treated with the LCP.
Complications, including infection, nonunion, and malunion, and secondary operations were determined.
After a mean of 26-month follow-up, 4 patients (6.0%) were treated for infections. Malunions occurred in 11% of LCP patients and in 1 ABP patient (3.4%, P = 0.14). All patients with malunions were older than 55 years. Seven patients (11%) were treated for nonunions. Six of the nonunions occurred after LCP (16% vs. 3.4%, P = 0.11) Complications were more frequent in LCP patients (35%) versus ABP patients (10%, P = 0.001). Complications were not related to fracture pattern, periprosthetic fracture, or open fracture. Mean age of patients with complications was 64 years (vs. 53 years, P = 0.01), and they were more likely to have lower energy mechanisms (P = 0.017). Overall, 18 patients (27%) underwent secondary procedures, including treatment of infection, nonunion, malunion, or prominent implant removal. Secondary procedures were more common after LCP (43%) versus ABP (6.9%, P = 0.0008) patients. Painful prominent implants were removed from 7 LCP patients (18%) and no ABP patients (P = 0.01).
Distal femur fractures are often associated with prolonged healing and rehabilitation times, which increase substantially when complications occur. Internal fixation of these fractures may be performed successfully with ABP or LCP. In our review of fractures that could be treated with either implant, patients treated with locking plates had more complications and nonunions, requiring more secondary procedures to treat complications and to remove prominent implants. Furthermore, locking plates are substantially more expensive than conventional fixed-angle devices. Future investigation is needed in the form of a large randomized prospective study to clearly define clinical differences, functional outcomes, and costs of care.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
在股骨远端，当冠状骨折排除使用传统的固定角度装置时，锁定钢板是有效的。然而，对于髁上骨折模式，几乎没有比较数据，这些模式可以用其他装置治疗。本研究的目的是通过评估并发症和二次手术来比较 95 度角刀片钢板（ABP）和锁定髁钢板（LCP），这些并发症和二次手术适用于两种植入物治疗的骨折。
回顾性研究。
1 级创伤中心。
患者/参与者：71 例股骨远端骨折患者（OTA 33-A、33-C1、33-C2），71 例患者中 71 例（OTA 33-A、33-C1、33-C2）可采用 ABP 或 LCP 治疗，平均年龄 59.5 岁（范围 20-92 岁）。17 例骨折（24%）发生在膝关节假体附近（10 例 ABP 和 7 例 LCP）。两组在年龄、骨折类型和开放性骨折方面相似。大多数损伤是由高能创伤引起的，21%为开放性骨折。
32 例（45%）采用 ABP 治疗，39 例（55%）采用 LCP 治疗。
包括感染、骨不连和畸形愈合以及二次手术的并发症。
平均随访 26 个月后，4 例（6.0%）患者因感染接受治疗。11%的 LCP 患者和 1 例 ABP 患者（3.4%，P=0.14）出现畸形愈合。所有畸形愈合患者均年龄大于 55 岁。7 例（11%）患者发生骨不连。6 例非骨不连发生在 LCP 后（16%比 3.4%，P=0.11）。LCP 患者的并发症发生率（35%）明显高于 ABP 患者（10%，P=0.001）。并发症与骨折类型、假体周围骨折或开放性骨折无关。并发症患者的平均年龄为 64 岁（vs. 53 岁，P=0.01），且更有可能发生低能量机制（P=0.017）。总的来说，18 例患者（27%）接受了二次手术，包括感染、骨不连、畸形愈合或突出植入物的去除。LCP（43%）患者的二次手术明显多于 ABP（6.9%，P=0.0008）患者。7 例 LCP 患者（18%）和无 ABP 患者（P=0.01）出现疼痛性突出植入物。
股骨远端骨折常伴有愈合和康复时间延长，当出现并发症时，愈合和康复时间会大大延长。这些骨折可以用 ABP 或 LCP 成功固定。在我们对可采用任何一种植入物治疗的骨折的回顾中，采用锁定钢板治疗的患者并发症和骨不连更多，需要更多的二次手术来治疗并发症和去除突出的植入物。此外，锁定钢板的价格明显高于传统的固定角度装置。未来需要进行大样本随机前瞻性研究，以明确界定临床差异、功能结果和治疗费用。
治疗水平 III。有关证据水平的完整描述，请参见作者说明。
