Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
J Orthop Trauma. 2023 Apr 1;37(4):175-180. doi: 10.1097/BOT.0000000000002553.
To determine patient, fracture, and construct related risk factors associated with nonunion of distal femur fractures.
Retrospective cohort study.
Academic Level I trauma center.
Patients 18 years and older presenting with OTA/AO 33A and 33C distal femur fractures from 2004 to 2020. A minimum follow-up of 6 months was required for inclusion. OTA/AO 33B and periprosthetic fractures were excluded, 438 patients met inclusion criteria for the study.
The primary outcome of the study was fracture nonunion defined as a return to the OR for management of inadequate bony healing. Patient demographics, comorbidities, injury characteristics, fixation type, and construct variables were assessed for association with distal femur fracture nonunion. Secondary outcomes include conversion to total knee arthroplasty, surgical site infection, and other reoperation.
The overall nonunion rate was 13.8% (61/438). The nonunion group was compared directly with the fracture union group for statistical analysis. There were no differences in age, sex, mechanism of injury, Injury Severity Score, and time to surgery between the groups. Lateral locked plating characteristics including length of plate, plate metallurgy, screw density, and working length were not significantly different between groups. Increased body mass index [odds ratio (OR), 1.05], chronic anemia (OR, 5.4), open fracture (OR, 3.74), and segmental bone loss (OR, 2.99) were independently associated with nonunion. Conversion to total knee arthroplasty (TKA) ( P = 0.005) and surgical site infection ( P < 0001) were significantly more common in the nonunion group.
Segmental bone loss, open fractures, chronic anemia, and increasing body mass index are significant risk factors in the occurrence of distal femoral nonunion. Lateral locked plating characteristics did not seem to affect nonunion rates. Further investigation into the prevention of nonunion should focus on fracture fixation constructs and infection prevention.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
确定与股骨远端骨折不愈合相关的患者、骨折和结构相关的危险因素。
回顾性队列研究。
学术一级创伤中心。
2004 年至 2020 年期间，符合 OTA/AO33A 和 33C 股骨远端骨折并接受治疗的 18 岁及以上患者。纳入标准为至少随访 6 个月。排除 OTA/AO33B 和假体周围骨折，符合研究标准的患者共 438 例。
本研究的主要结果是骨折不愈合，定义为因骨愈合不良而返回手术室进行治疗。评估患者的人口统计学、合并症、损伤特征、固定类型和结构变量与股骨远端骨折不愈合的关系。次要结果包括转为全膝关节置换术、手术部位感染和其他再次手术。
总体不愈合率为 13.8%（61/438）。对不愈合组和骨折愈合组进行直接比较进行统计学分析。两组在年龄、性别、损伤机制、损伤严重程度评分和手术时间方面无差异。外侧锁定钢板的特征，包括钢板长度、钢板金属材料、螺钉密度和工作长度，两组之间无显著差异。增加的体重指数[比值比（OR），1.05]、慢性贫血（OR，5.4）、开放性骨折（OR，3.74）和节段性骨丢失（OR，2.99）与不愈合独立相关。转为全膝关节置换术（TKA）（ P = 0.005）和手术部位感染（ P < 0001）在不愈合组中更为常见。
节段性骨丢失、开放性骨折、慢性贫血和体重指数增加是股骨远端骨折不愈合的显著危险因素。外侧锁定钢板的特征似乎并不影响不愈合率。进一步研究预防不愈合应集中在骨折固定结构和感染预防上。
预后 III 级。请参阅作者说明以获取完整的证据水平描述。
