Department of Orthopedics and Traumatology, San Carlo Borromeo Hospital, Milan, Italy.
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Acta Biomed. 2022 Mar 14;93(1):e2022005. doi: 10.23750/abm.v93i1.12091.
The treatment of distal femur fractures represents a challenging task. General and local factors, including bone quality, articular surface involvement, fracture comminution, associated soft tissue injuries and ultimately fixation system, all play a role in the final clinical outcome. Current surgical approaches often undermine patellar vascularization and integrity of the extensor apparatus, not guaranteeing sufficient visualization of the medial condyle. This technical note presents the efficacy and safety a new surgical technique to address distal femoral fractures.
The original "swashbuckler" surgical approach was modified in order to obtain a better visualization of the lateral and medial femoral condyles without affecting the knee extensor mechanism and the anastomotic arterial supply of the patella. This modified surgical approach was utilized in a consecutive series of patients presenting with an AO Foundation/Orthopaedic Trauma Association (AO/OTA) 33 distal femur or periprosthetic fracture of the knee. The final outcome was recorded according to a functional evaluation scoring system.
Twelve patients (2 males and 10 females) with a mean age of 67,8 years were included in this series. The same, modified "swashbuckler" surgical approach was applied in all cases. Multiple internal fixation techniques, including a single lateral plate, a combination of a lateral and medial plate, a single lateral plate associated with lag screws, were used to obtain a satisfactory stabilization of the fracture site. All patients were reviewed at a minimum one-year follow up (median 15 months): all patients regained their level of activities of daily living. No major intraoperative or postoperative complications were recorded.
The modified swashbuckler approach allows anatomical reduction and appropriate fixation without sacrificing the blood supply to the patella and ensures rapid weight bearing resumption thanks to an intact extensor mechanism.
股骨远端骨折的治疗是一项具有挑战性的任务。包括骨质量、关节面受累、骨折粉碎程度、相关软组织损伤以及最终固定系统在内的一般和局部因素都对最终临床结果产生影响。目前的手术方法往往会破坏髌骨关节的血供和伸肌装置的完整性，无法确保对内侧髁的充分可视化。本技术说明介绍了一种新的手术技术治疗股骨远端骨折的疗效和安全性。
对原始的“swashbuckler”手术入路进行了改良，以便在不影响膝关节伸肌机制和髌骨关节吻合动脉供应的情况下，更好地观察股骨内外侧髁。这种改良的手术入路用于一系列连续的 AO 基金会/骨科创伤协会（AO/OTA）33 型股骨远端或膝关节假体周围骨折患者。最终结果根据功能评估评分系统进行记录。
本系列包括 12 例患者（2 名男性和 10 名女性），平均年龄为 67.8 岁。所有病例均采用相同的改良“swashbuckler”手术入路。采用多种内固定技术，包括单一外侧钢板、外侧和内侧钢板联合固定、单一外侧钢板联合拉力螺钉固定，以获得骨折部位的满意稳定。所有患者均在至少 1 年的随访中进行了评估（中位数为 15 个月）：所有患者均恢复了日常生活活动水平。未记录到重大术中或术后并发症。
改良的 swashbuckler 入路可实现解剖复位和适当固定，同时不会牺牲髌骨关节的血供，并通过完整的伸肌机制确保快速承重。
