Salazar Brett P, Babian Aaron R, DeBaun Malcolm R, Githens Michael F, Chavez Gustavo A, Goodnough L Henry, Gardner Michael J, Bishop Julius A
Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA.
J Orthop Trauma. 2021 Jan 1;35(1):2-9. doi: 10.1097/BOT.0000000000001867.
The management of geriatric distal femur fractures is controversial, and both primary distal femur replacement (DFR) and surgical fixation (SF) are viable treatment options. The purpose of this study was to compare patient outcomes after these treatment strategies.
PubMed, Embase, and Cochrane databases were searched for English language articles up to April 24, 2020, identifying 2129 papers.
Studies evaluating complications in elderly patients treated for distal femur fractures with either immediate DFR or SF were included. Studies with mean patient age <55 years, nontraumatic indications for DFR, or SF with nonlocking plates were excluded.
Two studies provided Level II or III evidence, whereas the remaining 28 studies provided Level IV evidence. Studies were formally evaluated for methodological quality using established criteria. Treatment failure between groups was compared using an incidence rate ratio.
Treatment failure was defined for both SF and arthroplasty as complications requiring a major reoperation for reasons such as mechanical failure, nonunion, deep infection, aseptic loosening, or extensor mechanism disruption. There were no significant differences in complication rates or knee range of motion between SF and DFR.
SF and DFR for the treatment of geriatric distal femur fractures demonstrate similar overall complication rates. Given the available evidence, no strong conclusions on the comparative effectiveness between the 2 treatments can be definitively made. More rigorous prospective research comparing SF vs. DFR to treat acute geriatric distal femur fractures is warranted.
Therapeutic Level IV. See instructions for authors for a complete description of levels of evidence.
老年股骨远端骨折的治疗存在争议，初次股骨远端置换术（DFR）和手术固定（SF）都是可行的治疗选择。本研究的目的是比较这些治疗策略后的患者结局。
检索了PubMed、Embase和Cochrane数据库，查找截至2020年4月24日的英文文章，共识别出2129篇论文。
纳入评估采用即刻DFR或SF治疗股骨远端骨折的老年患者并发症的研究。排除平均患者年龄<55岁、DFR的非创伤性适应证或采用非锁定钢板的SF的研究。
两项研究提供了II级或III级证据，其余28项研究提供了IV级证据。使用既定标准对研究的方法学质量进行正式评估。采用发病率比比较组间治疗失败情况。
SF和关节成形术的治疗失败均定义为因机械故障、骨不连、深部感染、无菌性松动或伸肌机制破坏等原因需要进行再次大手术的并发症。SF和DFR之间的并发症发生率或膝关节活动范围无显著差异。
SF和DFR治疗老年股骨远端骨折的总体并发症发生率相似。鉴于现有证据，无法就这两种治疗方法的比较有效性得出明确结论。有必要进行更严格的前瞻性研究，比较SF与DFR治疗急性老年股骨远端骨折的效果。
治疗性IV级。有关证据级别的完整描述，请参阅作者指南。
