Department of Orthopedic Surgery, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Eur J Trauma Emerg Surg. 2022 Oct;48(5):4105-4111. doi: 10.1007/s00068-022-01940-z. Epub 2022 Mar 6.
Augmenting fracture fixation with intramedullary fibular graft has seen several applications such as in comminuted proximal humerus fractures, and femoral neck and shaft nonunion. The purpose of this study was to report the first case series demonstrating the novel application of an intramedullary fibular allograft strut and dual locking plates on complicated periprosthetic fracture of distal femur.
The patient demographics, weight-bearing status, and radiographic and clinical outcomes of six patients, who were treated for periprosthetic distal femur fractures using an intramedullary fibular allograft strut and dual locking plate, between January 2018 and April 2020 were analyzed.
Postoperative range of knee motion showed median 10' (range 10-20) of flexion contracture and 90' (range 80-110) of further flexion. Postoperative joint function was assessed according to the Kolmert functional criteria, with "excellent to good" in angular deformity and "Good to fair" result in range of motion and pain. RUSH score was assessed, and median score was 24 (range 18-26). All patients were able to ambulate without assistance 6 months after surgery.
In summary, the application of fibular strut graft and dual locking plate might be an option in complicated distal femur fracture above total knee arthroplasty. Albeit with an available number, such application showed promise as an intramedullary and cortical support for both reduction and maintenance of correction alignment, length, and prevention of further angular deformity.
Surgical technique and Cases-series.
髓内腓骨移植增强骨折固定已在多种应用中得到应用，如粉碎性肱骨近端骨折、股骨颈和骨干骨不连。本研究的目的是报告首例应用髓内腓骨同种异体移植物支柱和双锁定钢板治疗复杂膝关节假体周围股骨远端骨折的病例系列。
分析了 2018 年 1 月至 2020 年 4 月期间，6 例使用髓内腓骨同种异体移植物支柱和双锁定钢板治疗膝关节假体周围股骨远端骨折的患者的患者人口统计学、负重状态以及影像学和临床结果。
膝关节运动范围术后中位数为 10'（范围 10-20）的屈曲挛缩和 90'（范围 80-110）的进一步屈曲。术后关节功能根据 Kolmert 功能标准进行评估，在角度畸形方面为“优至良”，在活动度和疼痛方面为“良至尚可”。RUSH 评分评估，中位数评分为 24 分（范围 18-26 分）。所有患者术后 6 个月均可在无辅助下行走。
总之，腓骨支柱移植物和双锁定钢板的应用可能是全膝关节置换术后复杂股骨远端骨折的一种选择。尽管数量有限，但这种应用为复位和维持矫正对线、长度以及预防进一步的角度畸形提供了髓内和皮质支撑，具有很大的应用前景。
证据等级 IV：手术技术和病例系列。
