Department of Orthopaedic Surgery, Atlanta, Georgia.
Department of Orthopaedic Surgery, Nashville, Tennessee.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S450-S458. doi: 10.1016/j.arth.2023.01.044. Epub 2023 Feb 2.
Open reduction and internal fixation (ORIF) and distal femoral replacement (DFR) have been utilized in the management of periprosthetic distal femur fractures. At present, much of the literature has been limited to small retrospective series. The purpose of the current investigation was to present the results of pooled data to determine the complication rates associated with ORIF and DFR.
Publications from 2010 to 2020 describing 10 or more periprosthetic distal femur fractures treated with ORIF (ie, single plate, intramedullary nail, and dual fixation) or DFR were included, resulting in 32 publications and 1,258 fractures (977 ORIF and 281 DFR). Occurrence of surgical complications, reoperations, and medical complications were evaluated and compared.
The rate of surgical complications (ORIF versus DFR, 20.5 versus 14.9%, P = 1.0) and reoperations (12.9 versus 12.5%, P = 1.0) following DFR were similar. However, pooled analyses demonstrated that patients treated with DFR had a higher medical complication rate (ORIF versus DFR, 8.5 versus 23.1%, P = .0006).
ORIF and DFR for the treatment of periprosthetic distal femur fractures have similar surgical complication and reoperation profiles. While this review found an increased rate of medical complication following DFR, there are limitations in quality reporting in the literature, which should be considered when interpreting the study's findings. Failed ORIF can be salvaged with DFR, but the difficulty of this reoperation is dependent on the ORIF technique that was used. With future prospective studies, this review can help guide management of these fractures.
切开复位内固定（ORIF）和股骨远端置换（DFR）已被用于治疗假体周围股骨远端骨折。目前，大量文献仅限于小回顾性系列研究。本研究的目的是提出汇总数据的结果，以确定与 ORIF 和 DFR 相关的并发症发生率。
纳入了 2010 年至 2020 年期间描述了 10 例或更多假体周围股骨远端骨折采用 ORIF（即单钢板、髓内钉和双固定）或 DFR 治疗的文献，共纳入 32 篇文献和 1258 例骨折（977 例 ORIF 和 281 例 DFR）。评估和比较了手术并发症、再次手术和医疗并发症的发生情况。
DFR 组的手术并发症发生率（ORIF 与 DFR 比较，20.5%与 14.9%，P=1.0）和再次手术率（12.9%与 12.5%，P=1.0）相似。然而，汇总分析显示，DFR 组的医疗并发症发生率较高（ORIF 与 DFR 比较，8.5%与 23.1%，P=0.0006）。
ORIF 和 DFR 治疗假体周围股骨远端骨折的手术并发症和再次手术率相似。虽然本研究发现 DFR 后医疗并发症发生率增加，但文献中存在质量报告的局限性，在解释研究结果时应予以考虑。ORIF 失败后可采用 DFR 挽救，但这种再手术的难度取决于 ORIF 技术的应用。随着未来前瞻性研究的开展，本研究可以为这些骨折的治疗提供指导。
