Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, PO Box 980153, Richmond, VA, 23298, USA.
KC Orthopedic Alliance, UMKC, 3651 College Blvd, Leawood, KS, 66211, USA.
Eur J Orthop Surg Traumatol. 2023 Aug;33(6):2541-2546. doi: 10.1007/s00590-022-03468-9. Epub 2023 Jan 12.
Comminution is an aspect of periprosthetic distal femoral fractures (PDFFs) that can influence postoperative outcomes and treatment selection, but is not included in current classification systems. We propose a new classification system for PDFFs based on comminution and cortical reads. This study aims to prove its reliability and efficacy to predict fracture severity and guide treatment.
A retrospective chart review of patients treated with single or dual locking plates for PDFFs was performed. Two fellowship-trained orthopedic joint reconstruction specialists used available imaging to classify each PDFF as either type 1 (minimal or no comminution allowing for reconstruction of medial and lateral cortices), type 2 (comminution reasonably allowing for reconstruction of either medial or lateral cortex), and type 3 (extensive comminution not allowing reasonable reconstruction of medial or lateral cortex). Each PDFF was then analyzed for radiographic outcomes including lateral distal femoral angle (LDFA) and the posterior distal femoral angle (PDFA).
Interobserver reliability assessed by Cohen's Kappa statistic was 0.707, and average intraobserver reliability was 0.843, showing substantial reliability. Type 3 PDFFs had greater varus deformity than type 1 (p = 0.0457) or 2 (0.0198).
The proposed classification system accounts for comminution, demonstrates strong interobserver and intraobserver reliability, and can be used to guide treatment in regard to single versus dual plating.
Retrospective comparative study, Level IV.
粉碎是假体周围股骨远端骨折（PDFF）的一个方面，它可以影响术后结果和治疗选择，但目前的分类系统并不包括这一因素。我们提出了一种基于粉碎和皮质读取的新的 PDFF 分类系统。本研究旨在证明其可靠性和有效性，以预测骨折严重程度并指导治疗。
对接受单或双锁定板治疗 PDFF 的患者进行回顾性图表审查。两名接受过 fellowship 培训的骨科关节重建专家利用现有影像学资料对每个 PDFF 进行分类，分为 1 型（粉碎程度最小或无，允许重建内侧和外侧皮质）、2 型（粉碎程度合理，允许重建内侧或外侧皮质中的任意一个）和 3 型（广泛粉碎，无法合理重建内侧或外侧皮质）。然后对每个 PDFF 的影像学结果进行分析，包括外侧股骨远端角（LDFA）和后股骨远端角（PDFA）。
通过 Cohen Kappa 统计评估的观察者间可靠性为 0.707，平均观察者内可靠性为 0.843，显示出较强的可靠性。3 型 PDFF 的内翻畸形比 1 型（p=0.0457）或 2 型（0.0198）更大。
所提出的分类系统考虑了粉碎程度，具有较强的观察者间和观察者内可靠性，可用于指导单或双板固定治疗。
回顾性比较研究，IV 级。
