Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
Royal Sussex County Hospital, Eastern Road, Brighton, BN2 5BE, UK.
Injury. 2021 Jul;52(7):1918-1924. doi: 10.1016/j.injury.2021.04.014. Epub 2021 Apr 20.
Interprosthetic femoral fractures (IFF) are rare but increasing with an ageing population. Operative management is challenging and there is currently a paucity of outcome data in literature. The purpose of this study was to evaluate outcomes of IFFs managed with modern distal femoral locking plates, in a larger sample size than previously published.
This retrospective study reviewed 49 closed IFFs in 48 patients at a major trauma center from 2009 to 2019 occurring between previous total hip arthroplasty (n=38), hemi hip arthroplasty (n=3), dynamic hip screw (n=6) or cephalomedullary nail (n=2) and total knee arthroplasty. They were managed with Minimally Invasive Plate Osteosynthesis (MIPO) employing modern biological fixation techniques and stabilised with VA-LCP Condylar (Synthes; n=28) or Peri-Loc (S&N; n=21) plate. Clinical and radiographic outcomes were measured.
The majority of fractures were in female patients (80%), who were elderly (average 83 years), and comorbid (55% ASA grade 3 or 4). Most fractures were Pires type IIA and OTA/AO type 33A. Average plate spanning femur was 16 holes, with average working length of 6 holes. 86% had unrestricted weight bearing immediately post operatively. 31 fractures reached radiological (n=25) or clinical (n=6) union. 13 patients died with 2 lost to follow up. There were 3 non-unions, with implant failure occurring before 4 months in all 3. We present a union rate of 91% (n=31/34).
IFFs are occurring with increasing frequency in a frail elderly population. In patients with IFFs, MIPO and biological fixation techniques using modern distal femoral locking plates can achieve high rate of union when combined with immediate unrestricted weight bearing postoperatively.
人工关节间股骨骨折（IFF）较为罕见，但随着人口老龄化，其发病率逐渐升高。此类骨折的手术治疗极具挑战性，目前文献中此类骨折的疗效数据十分有限。本研究旨在通过较大样本量评估在大型创伤中心采用现代股骨远端锁定钢板治疗 IFF 的疗效。
本回顾性研究纳入了 2009 年至 2019 年期间在一家大型创伤中心治疗的 48 例 49 例闭合性 IFF 患者，其中 38 例患者既往行全髋关节置换术（THA），3 例患者行半髋关节置换术（HHA），6 例患者行动力髋螺钉内固定术（DHS），2 例患者行股骨近端髓内钉内固定术。所有患者均采用微创钢板接骨术（MIPO），采用现代生物学固定技术，并采用 VA-LCP 髁钢板（Synthes；n=28）或 Peri-Loc 钢板（S&N；n=21）固定。测量临床和影像学结果。
大多数患者为女性（80%），年龄较大（平均 83 岁）且合并多种疾病（55%美国麻醉医师协会分级 3 或 4 级）。大多数骨折为 Pires ⅡA型和 OTA/AO 33A 型。平均钢板跨越股骨 16 个孔，平均工作长度为 6 个孔。86%的患者术后可立即不受限制地负重。25 例患者达到影像学愈合，6 例患者达到临床愈合。13 例患者死亡，2 例患者失访。有 3 例骨折不愈合，所有患者的内固定物均在 4 个月内失效。我们的愈合率为 91%（n=31/34）。
IFF 在体弱的老年人群中发病率逐渐升高。对于 IFF 患者，采用 MIPO 和现代股骨远端锁定钢板的生物学固定技术，术后立即允许不受限制地负重，可获得较高的愈合率。
