Li Ruiyang, Zhuge Yingjie, Zhan Yu, Xie Xuetao, Luo Congfeng
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Ann Transl Med. 2022 Apr;10(7):398. doi: 10.21037/atm-21-4591.
Distal femur fractures are complex injuries with a high rate of fracture healing problems. Since the widespread of computed tomographic imaging in the diagnosis of distal femur fractures, many fracture characteristics have been discovered. This study aimed to depict the location and frequency of distal femur fracture lines and further analyze the morphological characteristics using the 3-dimensional computed tomography (CT) mapping technique, thus providing more information to solve this challenging clinical problem.
In total, 217 distal femur fractures in 216 patients were retrospectively reviewed. Fracture fragments on CT were digitally reconstructed and virtually reduced to match a template model. The contour of every fracture fragment was then marked with smooth curves, and the overlap of all fracture lines allowed for the creation of 3-dimensional fracture maps and heat maps. Fracture characteristics were summarized based on these maps.
This study included 114 left knee injuries, 101 right knee injuries, and 1 case with bilateral injury. Distal femur fractures were most likely to occur among patients aged 61 to 70 years. On the heat map of all 217 fractures, fracture line hot zones were mainly concentrated around the metaphysis, the lateral part of the intercondylar notch, and the patellofemoral joint. Distal femur fractures with three Arbeitsgemeinschaft für Osteosynthesefragen Foundation/Orthopaedic Trauma Association (AO/OTA) types demonstrated distinct fracture characteristics. In total, there were 58 coronal plane fractures (41.1%) in 141 intercondylar fractures.
The intercondylar fracture patterns in AO/OTA type B and type C fractures were similar, while the supracondylar characteristics in AO/OTA type A and type C were different. The findings in this study can help orthopaedic surgeons better understand the fracture morphology on the basis of AO/OTA classification. Further studies are needed to establish a standard biomechanical fracture model and new fixation strategy for better clinical outcomes.
股骨远端骨折是复杂的损伤，骨折愈合问题发生率高。自从计算机断层扫描成像广泛应用于股骨远端骨折的诊断以来，已发现许多骨折特征。本研究旨在描绘股骨远端骨折线的位置和频率，并使用三维计算机断层扫描（CT）映射技术进一步分析形态学特征，从而为解决这一具有挑战性的临床问题提供更多信息。
回顾性分析216例患者的217例股骨远端骨折。对CT上的骨折碎片进行数字重建并虚拟复位以匹配模板模型。然后用平滑曲线标记每个骨折碎片的轮廓，所有骨折线的重叠形成三维骨折图和热图。根据这些图总结骨折特征。
本研究包括114例左膝损伤、101例右膝损伤和1例双侧损伤。股骨远端骨折最常发生在61至70岁的患者中。在所有217例骨折的热图上，骨折线热点区域主要集中在干骺端、髁间切迹外侧部分和髌股关节周围。具有三种 Arbeitsgemeinschaft für Osteosynthesefragen 基金会/骨科创伤协会（AO/OTA）类型的股骨远端骨折表现出不同的骨折特征。在141例髁间骨折中，共有58例冠状面骨折（41.1%）。
AO/OTA B型和C型骨折的髁间骨折模式相似，而AO/OTA A型和C型骨折的髁上特征不同。本研究结果有助于骨科医生在AO/OTA分类的基础上更好地理解骨折形态。需要进一步研究以建立标准的生物力学骨折模型和新的固定策略，以获得更好的临床结果。
