*Division of Orthopaedics, Department of Surgery, Hamilton General Hospital, McMaster University, Hamilton, Canada; and †Division of Orthopaedics, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
J Orthop Trauma. 2014 May;28(5):307-12. doi: 10.1097/BOT.0000000000000002.
To systematically review and compare nonoperative and operative treatments for the management of periprosthetic distal femur fractures adjacent to total knee arthroplasties. Specific operative interventions compared included locked plating, retrograde intramedullary nailing (RIMN), and conventional (nonlocked) plating. Where possible, data were pooled to arrive at summary estimates of treatment effect [odds ratios (ORs) with associated 95% confidence intervals (CIs)].
A comprehensive database search (via Pubmed, Medline, Cochrane Database, and the Orthopaedic Trauma Association database) was completed, yielding 44 eligible studies with a total of 719 fractures for analysis. Pertinent outcomes including malunion, nonunion, and the need for secondary surgical procedures were compared statistically.
Both locked plating and RIMN demonstrated significant advantages over nonoperative treatment. Some advantages were also observed when locked plating and RIMN were compared with conventional (nonlocked) plates. Comparison of locked plating and RIMN showed no significant differences with regard to nonunion rates (OR = 0.39, 95% CI = 0.13-1.15; P = 0.09) or rate of secondary surgical procedures (OR = 0.65, 95% CI = 0.31-1.35; P = 0.25). However, RIMN demonstrated a significantly higher malunion rate when compared with locked plating (OR = 2.37, 95% CI = 1.17-4.81; P = 0.02).
Locked plating and RIMN offer significant advantages over nonoperative treatment and conventional (nonlocked) plating techniques in the management of periprosthetic femur fractures above total knee arthroplasties. Locked plating demonstrated a trend toward increased nonunion rates when compared with RIMN. Malunion was significantly higher with RIMN compared with locked plating.
系统回顾和比较非手术和手术治疗全膝关节置换术后假体周围股骨远端骨折的方法。比较的具体手术干预措施包括锁定钢板、逆行髓内钉（RIMN）和传统（非锁定）钢板。在可能的情况下，对数据进行汇总，得出治疗效果的综合估计值[比值比（ORs）及相关 95%置信区间（CIs）]。
通过 Pubmed、Medline、Cochrane 数据库和矫形创伤协会数据库进行全面的数据库检索，共纳入 44 项符合条件的研究，共 719 例骨折进行分析。统计学比较了畸形愈合、不愈合和需要二次手术等相关结局。
锁定钢板和 RIMN 均明显优于非手术治疗。与传统（非锁定）钢板相比，锁定钢板和 RIMN 也显示出一些优势。锁定钢板和 RIMN 比较，不愈合率无显著差异（OR=0.39，95%CI=0.13-1.15；P=0.09）或二次手术率（OR=0.65，95%CI=0.31-1.35；P=0.25）。然而，与锁定钢板相比，RIMN 畸形愈合率明显更高（OR=2.37，95%CI=1.17-4.81；P=0.02）。
锁定钢板和 RIMN 在全膝关节置换术后假体周围股骨骨折的治疗中优于非手术治疗和传统（非锁定）钢板技术。与 RIMN 相比，锁定钢板的不愈合率有增加的趋势。与锁定钢板相比，RIMN 的畸形愈合发生率明显更高。
