University Of Louisville Department of Orthopaedic Surgery 550 S. Jackson St., 1st Floor ACB building Louisville, KY 40202.
University Of Louisville Department of Orthopaedic Surgery 550 S. Jackson St., 1st Floor ACB building Louisville, KY 40202.
Injury. 2021 Apr;52(4):967-970. doi: 10.1016/j.injury.2020.11.061. Epub 2020 Nov 28.
The treatment of intercondylar distal femur fractures requires anatomic reduction of intra-articular fragments and absolute fixation. Preoperative planning is necessary to understand fracture morphology. All fracture lines need to be recognized as the primary implant may not capture all articular fragments, mainly when coronal plane fractures are present. Oftentimes, independent interfragmentary compression screws are necessary. No recent studies have visually mapped out the distal femur articular fracture fragments necessary for absolute fixation. The objectives of this study are to determine the frequency of coronal plane fractures in intercondylar distal femur fractures and describe the pattern of intra-articular fracture fragments.
The hospital's trauma registry was queried for distal femur ORIF CPT codes logged in the past four years. A retrospective chart review was performed using the EMR and CT scans. Demographics and mechanisms of injury were analyzed. Fracture fragments were surveyed and drawn out by hand on a template for easy organization. Patients' fractures were categorized into the following groups: fractures with no intra-articular coronal plane fractures, those with medial coronal fractures, those with lateral coronal fractures, or those with both medial and lateral coronal fractures. Major fracture fragments were identified.
A total of 55 patients were included. 26 patients (47%) were found to have no intra-articular coronal plane fractures; 6 patients (11%) were found to have medial coronal plane fractures; 15 patients (27%) were found to have lateral coronal plane fractures, and 8 patients (15%) had medial and lateral coronal plane fractures. Collectively, intra-articular coronal plane fractures were identified in 29 patients (53%) with intercondylar distal femur fractures. Four major fracture fragments along with intercondylar and condylar comminution sites were identified.
Distal femur intra-articular coronal plane fractures can yield large anterior and posterior condylar fracture fragments of either the medial condyle, lateral condyle, or both condyles. Coronal plane fracture fragments must be identified to obtain absolute fixation. Our study found a higher coronal plane fracture line frequency (52.7%) than prior commonly cited studies. Surgeons must be on the lookout for anterior fracture fragments, posterior fracture fragments, and articular comminution when treating intercondylar femur fractures.
髁间远端股骨骨折的治疗需要解剖复位关节内碎骨块并实现绝对固定。为了了解骨折形态，术前规划是必要的。所有骨折线都需要被识别出来，因为主要植入物可能无法捕获所有关节内碎骨块，尤其是存在冠状面骨折时。通常，需要独立的骨折块间加压螺钉。最近没有研究直观地描绘出髁间远端股骨骨折绝对固定所需的关节内骨折块。本研究的目的是确定髁间远端股骨骨折中冠状面骨折的频率，并描述关节内骨折块的模式。
在过去四年中，我们查询了医院创伤登记处记录的远端股骨切开复位内固定术（ORIF）的 CPT 编码。我们使用电子病历和 CT 扫描进行了回顾性图表审查。分析了人口统计学和损伤机制。通过手工在模板上调查和绘制骨折块，以便于组织。将患者的骨折分为以下几类：无关节内冠状面骨折的骨折、单纯内侧冠状面骨折、单纯外侧冠状面骨折或同时存在内侧和外侧冠状面骨折的骨折。确定了主要的骨折块。
共纳入 55 例患者。26 例（47%）患者无关节内冠状面骨折；6 例（11%）患者存在单纯内侧冠状面骨折；15 例（27%）患者存在单纯外侧冠状面骨折；8 例（15%）患者存在内外侧冠状面骨折。总共，在 55 例髁间远端股骨骨折患者中有 29 例（53%）存在关节内冠状面骨折。确定了 4 个主要的骨折块以及髁间和髁部粉碎部位。
股骨远端关节内冠状面骨折可导致内侧或外侧髁或两者的前、后髁的大块骨折块。为了实现绝对固定，必须识别冠状面骨折块。我们的研究发现冠状面骨折线的频率（52.7%）高于之前常引用的研究。在治疗髁间股骨骨折时，外科医生必须注意前骨折块、后骨折块和关节粉碎。
