Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China; Shanghai Trauma Emergency Center, Shanghai, 200072, China; Orthopedic Intelligent Minimally Invasive Diagnosis & Treatment Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
Injury. 2021 Jun;52(6):1614-1620. doi: 10.1016/j.injury.2021.01.003. Epub 2021 Jan 7.
Dual plate fixation has been reported to be effective in the treatment of comminuted distal femur fractures (DFFs). However, optimized use of the medial plate and screws is less studied. This study aimed to evaluate the effect of a hybrid configuration of the medial plate in dual plate fixation of comminuted DFFs in promoting fracture healing.
We retrospectively analyzed 62 patients with comminuted DFFs (AO/OTA 33-A3/33-C2/33-C3) from January 2015 to March 2020, who were either fixed with lateral locked plating augmented with hybrid locked medial plating (LP-HLMP, n = 32) or lateral locked plating (LLP, n = 30) alone. Specifically, compression screws were applied in the middle of the medial plate and flanked by locking ones at both ends. Baseline characteristics, radiological and clinical outcomes were reviewed and analyzed. Multivariate logistic regression analysis was used to identify predictive factors for early fracture healing, and risk factors for delayed union/nonunion.
Demographics including age, gender, smoking, diabetes, and injury mechanism were comparable between the two groups. Reduction quality was better in the LP-HLMP group (p < 0.001). Although the LP-HLMP group experienced longer duration of surgery (125 min vs. 100 min, p < 0.001), sign of healing at 3 months was more obvious in this group (75%, 24/32 vs. 30%, 9/30; p < 0.001). The LP-HLMP group also presented with higher union rate (93.8%, 30/32 vs. 56.7%, 17/30; p = 0.001) and lower reoperation rate (0%, 0/32 vs. 13.3%, 4/30; p = 0.049). Kolment score showed no statistical significance between the two groups. Multivariate analysis revealed that younger age (< 60 years) (OR 5.99, 95%CI 1.16 - 31.03; p = 0.001) and LP-HLMP fixation (OR 45.90, 95% CI 4.78 - 440.56; p = 0.001) predict early healing; while smoking (OR 17.80, 95% CI 2.41 - 131.49; p = 0.01) and fracture translation (OR 3.49, 95% CI 1.46 - 8.32; p = 0.01) were identified as risk factors for delayed union/nonunion.
Hybrid locked medial plating in this study favors the healing of comminuted DFFs and reduces reoperation. Additionally, smoking and suboptimal reduction (translation) predict delayed union/nonunion.
双钢板固定被报道可有效治疗粉碎性股骨远端骨折（DFF）。然而，对于内侧钢板和螺钉的优化使用研究较少。本研究旨在评估混合式内侧钢板在粉碎性 DFF 双钢板固定中促进骨折愈合的效果。
我们回顾性分析了 2015 年 1 月至 2020 年 3 月间的 62 例粉碎性 DFF（AO/OTA 33-A3/33-C2/33-C3）患者，他们要么采用外侧锁定钢板（LLP）联合混合式锁定内侧钢板（LP-HLMP）固定（n=32），要么单纯采用 LLP 固定（n=30）。具体来说，在中间应用加压螺钉，并在两端应用锁定螺钉。回顾并分析基线特征、影像学和临床结果。采用多变量逻辑回归分析确定早期骨折愈合的预测因素，以及延迟愈合/不愈合的风险因素。
两组的年龄、性别、吸烟、糖尿病和损伤机制等人口统计学特征无差异。LP-HLMP 组的复位质量更好（p<0.001）。虽然 LP-HLMP 组的手术时间更长（125 分钟比 100 分钟，p<0.001），但该组在 3 个月时愈合迹象更明显（75%，24/32 比 30%，9/30；p<0.001）。LP-HLMP 组的愈合率更高（93.8%，30/32 比 56.7%，17/30；p=0.001），再次手术率更低（0%，0/32 比 13.3%，4/30；p=0.049）。Kolment 评分在两组之间无统计学意义。多变量分析显示，年龄较小（<60 岁）（OR 5.99，95%CI 1.16-31.03；p=0.001）和 LP-HLMP 固定（OR 45.90，95%CI 4.78-440.56；p=0.001）是早期愈合的预测因素；而吸烟（OR 17.80，95%CI 2.41-131.49；p=0.01）和骨折移位（OR 3.49，95%CI 1.46-8.32；p=0.01）是延迟愈合/不愈合的风险因素。
本研究中混合式锁定内侧钢板有利于粉碎性 DFF 的愈合，并降低再次手术率。此外，吸烟和复位不佳（移位）可预测延迟愈合/不愈合。
