Doshi Hitendra K, Wenxian Png, Burgula Maitra Vaarun, Murphy Diarmuid Paul
Department of Orthopaedics and Traumatology, Tan Tock Seng Hospital, Jalan Tan Tock Seng, Singapore.
Geriatr Orthop Surg Rehabil. 2013 Mar;4(1):16-20. doi: 10.1177/2151458513496254.
Fractures of the distal femur comprise 4% to 6% of all femoral fractures. Elderly patients are predisposed to low-energy fractures due to osteoporosis. Treatment of these fractures in the elderly group remains a challenge. Our hypothesis is that locking plates inserted with minimally invasive plate osteosynthesis (MIPO) techniques will produce better results compared to those inserted by open technique. The objective of this study is to evaluate the clinical outcomes of MIPO technique using locking plates in the elderly patients.
A total of 24 elderly patients (mean age 73 years) with distal femur fractures treated using the MIPO technique (2007-2010) were reviewed retrospectively. Parameters analyzed included classification of fracture, time to fracture union, knee range of motion, functional knee score (Knee Society Score-Functional) at 6 months, and other significant complications. One patient was lost to follow-up.
In all, 88% of the fractures were extraarticular. The mean time to union was 13.48 (range: 8-28) weeks. Mean range of motion achieved at 6 months and beyond was 100° ranging from 0 to 30 (extension) to 90 to 140 (flexion). Functional knee scores at 6 months from fixation were satisfactory (mean score 88.8). There were no cases of implant failure, nonunion, and infection. In all, 6 (25%) patients developed deep vein thrombosis (DVT) in the early postoperative period, all of which were below the level of the knee joint.
Locking plates inserted using MIPO techniques in elderly patients with distal femur fractures appear to be promising based on clinical outcome measurements. However, there was a high incidence of DVT noted.
股骨远端骨折占所有股骨骨折的4%至6%。由于骨质疏松，老年患者易发生低能量骨折。老年组这些骨折的治疗仍然是一项挑战。我们的假设是，与采用开放技术置入锁定钢板相比，采用微创钢板接骨术（MIPO）技术置入锁定钢板将产生更好的效果。本研究的目的是评估在老年患者中使用锁定钢板的MIPO技术的临床疗效。
回顾性分析2007年至2010年采用MIPO技术治疗的24例老年股骨远端骨折患者（平均年龄73岁）。分析的参数包括骨折分类、骨折愈合时间、膝关节活动范围、6个月时的膝关节功能评分（膝关节协会评分-功能评分）以及其他重大并发症。1例患者失访。
总体而言，88%的骨折为关节外骨折。平均愈合时间为13.48周（范围：8至28周）。6个月及以后达到的平均活动范围为100°，从0至30°（伸展）到90至140°（屈曲）。固定后6个月时的膝关节功能评分令人满意（平均评分88.8）。没有植入物失败、骨不连和感染的病例。共有6例（25%）患者在术后早期发生深静脉血栓形成（DVT），均发生在膝关节以下水平。
基于临床疗效评估，在老年股骨远端骨折患者中采用MIPO技术置入锁定钢板似乎前景良好。然而，注意到DVT的发生率较高。
