Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States.
Orlando Health Orthopaedic Institute, Florida State College of Medicine, University of Central Florida College of Medicine, 1222 S Orange Ave, 5 Floor, Orlando, FL 32806, United States.
Injury. 2023 Feb;54(2):694-697. doi: 10.1016/j.injury.2022.11.029. Epub 2022 Nov 12.
Periprosthetic distal femur fractures (PPDFFs) are a common complication after total knee arthroplasty (TKA). In the setting of well-fixed TKA components, treatment options include retrograde intramedullary nailing (rIMN) or lateral locked plating. Treatment with rIMN has historically been associated with potential for extension deformity when using conventional nails. We hypothesized that the PPDFFs treated with an intramedullary nail with a specifically designed 10-degree distal bend for periprosthetic fractures would result in improved post-operative sagittal alignment compared to conventional intramedullary nails.
The study was conducted at a level-1 trauma center over a 12-year period (2010 - 2022). Patients over the age of 18 who sustained a PPDFF treated with rIMN were identified. The primary outcomes of the study were post-operative coronal and sagittal alignment determined by reviewing post-operative radiographs.
A total of 50 patients were included. Twenty-three patients were treated with a rIMN with a 10° distal bend. Twenty-seven patients were treated with a rIMN with distal bend of 5° The mean aPDFA for the 10° distal bend group was 81.7° compared to 92.8° in the 5° distal bend group (p<0.001). There were 3/23 (13%) significant sagittal plane deformities the 10° distal bend group compared to 11/27 (41%) in the 5° distal bend group (p = 0.03). There was one patient with a post-operative extension deformity in the 10° distal bend group compared to 11 patients in the 5° distal bend group (p = 0.02).
Retrograde intramedullary nailing of PPDFF with a 10° distal bend results in significantly better alignment in the sagittal plane when compared to a conventional 5° nail. The use of a 5° nail resulted in an extension deformity significantly more frequently. We therefore recommend the utilization of a rIMN with a 10° distal bend when treating PPDFFs.
Periprosthetic distal femur fractures are a common complication following total knee arthroplasty. While several studies report on the use of retrograde intramedullary nails in the treatment of periprosthetic distal femur fractures, there are limited reports of the use of a novel retrograde intramedullary nail with a 10° distal bend in the treatment of these injuries. Herein we present a radiographic study comparing coronal and sagittal postoperative alignment following treatment with retrograde intramedullary nails with a 10° distal bend versus conventional retrograde nails with a 5° distal bend.
全膝关节置换术后发生的股骨假体周围远端骨折（PPDFF）是一种常见并发症。在固定良好的 TKA 组件的情况下，治疗选择包括逆行髓内钉（rIMN）或外侧锁定板。使用传统钉子时，rIMN 治疗与发生伸展畸形的潜在风险相关。我们假设，使用专门设计用于假体周围骨折的具有 10 度远端弯曲的髓内钉治疗 PPDFF 会导致术后矢状面排列得到改善，与传统髓内钉相比。
该研究在一个 1 级创伤中心进行，时间跨度为 12 年（2010 年至 2022 年）。确定了年龄在 18 岁以上、采用逆行髓内钉治疗的 PPDFF 患者。该研究的主要结果是通过术后影像学检查确定术后冠状面和矢状面的排列。
共纳入 50 例患者。23 例患者采用 10°远端弯曲的 rIMN 治疗。27 例患者采用远端弯曲 5°的 rIMN 治疗。10°远端弯曲组的平均 aPDFA 为 81.7°，而 5°远端弯曲组为 92.8°（p<0.001）。10°远端弯曲组有 3/23（13%）出现明显的矢状面畸形，而 5°远端弯曲组有 11/27（41%）（p=0.03）。10°远端弯曲组有 1 例术后发生伸展畸形，而 5°远端弯曲组有 11 例（p=0.02）。
与传统的 5°钉子相比，逆行髓内钉治疗 PPDFF 时采用 10°远端弯曲可显著改善矢状面排列。使用 5°钉子会导致伸展畸形的发生率明显增加。因此，我们建议在治疗 PPDFF 时使用带有 10°远端弯曲的逆行髓内钉。
全膝关节置换术后发生的股骨假体周围远端骨折是一种常见并发症。虽然有几项研究报告了逆行髓内钉在治疗股骨假体周围远端骨折中的应用，但关于新型逆行髓内钉治疗这些损伤的报道有限，该钉具有 10°远端弯曲。在此，我们介绍了一项比较使用 10°远端弯曲逆行髓内钉与使用 5°远端弯曲传统逆行钉治疗后冠状面和矢状面术后对线的影像学研究。
