O'Neill Dillon C, Hakim Anne J, DeKeyser Graham J, Steffenson Lillia N, Schlickewei Carsten W, Marchand Lucas S, Barg Alexej, Haller Justin M
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
Department of Orthopaedics, Trauma and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany and.
OTA Int. 2023 Jan 13;6(1):e227. doi: 10.1097/OI9.0000000000000227. eCollection 2023 Mar.
Lateral locked plating (LLP) development has improved outcomes for distal femur fractures. However, there is still a modest rate of nonunion in fractures treated with LLP alone, with higher nonunion risk in high-energy fractures, intra-articular involvement, poor bone quality, severe comminution, or bone loss. Several recent studies have demonstrated both the safety and the biomechanical advantage of dual medial and lateral plating (DP). The purpose of this study was to evaluate the clinical outcomes of DP for native distal femoral fractures by performing a systematic review of the literature.
Studies reporting clinical outcomes for DP of native distal femur fractures were identified and systematically reviewed. Publications without full-text manuscripts, those solely involving periprosthetic fractures, or fractures other than distal femur fractures were excluded. Fracture type, mean follow-up, open versus closed fracture, number of bone grafting procedures, nonunion, reoperation rates, and complication data were collected. Methodologic study quality was assessed using the Coleman methodology score.
The initial electronic review and reverse inclusion protocol identified 1484 publications. After removal of duplicates and abstract review to exclude studies that did not discuss clinical treatment of femur fractures with dual plating, 101 potential manuscripts were identified and manually reviewed. After final review, 12 studies were included in this study. There were 199 fractures with average follow-up time of 13.72 months. Unplanned reoperations and nonunion occurred in 19 (8.5%) and 9 (4.5%) cases, respectively. The most frequently reported complications were superficial infection (n = 6, 3%) and deep infection (n = 5, 2.5%) postoperatively. Other complications included delayed union (n = 6, 3%) not requiring additional surgical treatment and knee stiffness in four patients (2%) necessitating manipulation under anesthesia or lysis of adhesions. The average Coleman score was 50.5 (range 13.5-72), suggesting that included studies were of moderate-to-poor quality.
Clinical research interest in DP of distal femoral fractures has markedly increased in the past few decades. The current data suggest that DP of native distal femoral fractures is associated with favorable nonunion and reoperation rates compared with previously published rates associated with LLP alone. In the current review, DP of distal femoral fractures was associated with acceptable rates of complications and generally good functional outcomes. More high-quality, directly comparable research is necessary to validate the conclusions of this review.
外侧锁定钢板（LLP）的发展改善了股骨远端骨折的治疗效果。然而，单纯使用LLP治疗的骨折仍有一定比例的不愈合，在高能骨折、关节内累及、骨质不佳、严重粉碎或骨缺损的情况下，不愈合风险更高。最近的几项研究证实了双侧内外侧钢板固定（DP）的安全性和生物力学优势。本研究的目的是通过对文献进行系统回顾，评估DP治疗原发性股骨远端骨折的临床效果。
检索并系统回顾报告原发性股骨远端骨折DP临床效果的研究。排除无全文的出版物、仅涉及假体周围骨折或股骨远端骨折以外的骨折的研究。收集骨折类型、平均随访时间、开放性骨折与闭合性骨折、植骨手术次数、不愈合、再次手术率及并发症数据。采用科尔曼方法学评分评估研究的方法学质量。
初步电子检索和反向纳入方案共识别出1484篇出版物。在去除重复文献并进行摘要审查以排除未讨论双侧钢板治疗股骨骨折临床情况的研究后，确定了101篇潜在手稿并进行人工审查。最终审查后，本研究纳入12项研究。共有199例骨折，平均随访时间为13.72个月。计划外再次手术和不愈合分别发生在19例（8.5%）和9例（4.5%）患者中。最常报告的并发症是术后浅表感染（n = 6，3%）和深部感染（n = 5，2.5%）。其他并发症包括延迟愈合（n = 6，3%，无需额外手术治疗）和4例患者（2%）出现膝关节僵硬，需要在麻醉下进行手法治疗或粘连松解。科尔曼评分平均为50.5（范围13.5 - 72），表明纳入研究的质量为中等至较差。
在过去几十年中，对股骨远端骨折DP的临床研究兴趣显著增加。目前的数据表明，与先前单独使用LLP报道的发生率相比，原发性股骨远端骨折DP的不愈合率和再次手术率更有利。在本次综述中，股骨远端骨折DP的并发症发生率可接受，功能结局总体良好。需要更多高质量、直接可比的研究来验证本综述的结论。
