Strotman Patrick K, Karunakar Madhav A, Seymour Rachel, Lack William D
*Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL; and †Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, NC.
J Orthop Trauma. 2017 Oct;31(10):538-544. doi: 10.1097/BOT.0000000000000887.
To determine the accuracy and reliability of radiographic cortical bridging criteria in predicting the final healing of supracondylar femur fractures after treatment with locked plating.
Retrospective review.
Two Level 1 trauma centers.
PATIENTS/PARTICIPANTS: Patients who presented with supracondylar femur fractures (OTA/AO 33A, C) and were treated with locking plate fixation between January 1, 2004, and January 1, 2011. The final study population included 82 fractures after excluding patients with open physes (n = 4), nondisplaced fractures (n = 4), early revision for technical failure (n = 4), or inadequate follow-up (n = 42).
Distal femur locking plate fixation.
Postoperative radiographs until final follow-up were assessed for cortical bridging at each cortex on anterior-posterior and lateral views. Images were analyzed independently by 3 orthopaedic traumatologists to allow for assessment of reliability. Final determination of union required both radiographic and clinical confirmation.
Assessment for any cortical bridging was the earliest accurate predictor of final union (95.1% accuracy at 4 months postoperatively), compared with criteria requiring bicortical bridging (93.9% accuracy at 6 months) and tricortical bridging (78% accuracy at 21 months). Any cortical bridging demonstrated a higher interobserver reliability (kappa = 0.73) relative to bicortical (kappa = 0.27) or tricortical bridging (kappa = 0.5).
Our results for plate fixation of supracondylar distal femur fractures mirror those previously described for intramedullary nailing of tibia shaft fractures. Any radiographic cortical bridging by 4 months postoperatively is an accurate and reliable predictor of final healing outcome after locking plate fixation of supracondylar femur fractures. Assessment for bicortical or tricortical bridging is less reliable and inaccurate during the first postoperative year.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定影像学皮质桥接标准在预测股骨髁上骨折采用锁定钢板治疗后最终愈合情况时的准确性和可靠性。
回顾性研究。
两家一级创伤中心。
患者/参与者：2004年1月1日至2011年1月1日期间因股骨髁上骨折（OTA/AO 33A、C型）就诊并接受锁定钢板固定治疗的患者。最终研究人群包括82例骨折患者，排除了骨骺开放患者（n = 4）、无移位骨折患者（n = 4）、因技术失败早期翻修患者（n = 4）或随访不充分患者（n = 42）。
股骨远端锁定钢板固定。
对术后直至最终随访的前后位和侧位X线片进行评估，观察每一皮质的皮质桥接情况。由3名骨科创伤专家独立分析图像，以评估可靠性。骨折愈合的最终判定需要影像学和临床确认。
与需要双侧皮质桥接（术后6个月时准确率为93.9%）和三侧皮质桥接（术后21个月时准确率为78%）的标准相比，评估任何皮质桥接是最终骨折愈合的最早准确预测指标（术后4个月时准确率为95.1%）。相对于双侧皮质桥接（kappa = 0.27）或三侧皮质桥接（kappa = 0.5），任何皮质桥接显示出更高的观察者间可靠性（kappa = 0.73）。
我们对股骨髁上远端骨折钢板固定的研究结果与先前描述的胫骨干骨折髓内钉固定的结果相似。术后4个月出现的任何影像学皮质桥接是股骨髁上骨折锁定钢板固定后最终愈合结果的准确可靠预测指标。在术后第一年，评估双侧或三侧皮质桥接的可靠性较低且不准确。
诊断性III级。有关证据水平的完整描述，请参阅作者须知。
