Gendya Amr Gamaleldin Mahmoud Khalil, El-Zaher El-Zaher Hassan, Zakaria Zeiad Mohamed, Awad Mohamed El Sayed, Metwaly Radwan Gamal Eldeen Abdelhamid
Department of Orthopaedic surgery, Ain Shams University, Cairo, Egypt.
Arthroplast Today. 2023 Mar 14;20:101113. doi: 10.1016/j.artd.2023.101113. eCollection 2023 Apr.
Distal femur fractures are considered challenging to manage, particularly in geriatric patients. Double plating (DP) is a technique that helps with earlier rehabilitation and return to preinjury level of activity. Distal femoral replacement (DFR) is an alternative technique in the management of these fractures that may help to solve problems like associated knee osteoarthritis, osteoporosis, and severely comminuted condyles. The current study compares the functional and radiological outcomes of DFR and DP in the management of these fractures among geriatric patients.
This randomized, comparative, interventional study was performed at a university hospital. A total of 30 patients who underwent DFR or DP after distal femur fractures (AO/OTA 33 A3, 33 C) were analyzed. The primary outcome was Knee Society Score (KSS), whereas secondary outcomes included postoperative complications rate, knee range of motion, reoperation rate, and operative time.
No significant difference was observed between DFR and DP except for the knee component of the KSS at a 12-month interval ( = .03) and knee range of motion at a 12-month interval ( = .001), both of which were in favor of DP. No significant difference in postoperative complications ( = .06), reoperation rate ( = 1.00), or operative time ( = .06) was noted.
DFR and DP had comparable functional (KSS) and radiological outcomes with no significant difference in postoperative complications, reoperation rate, or operative time.
股骨远端骨折的治疗颇具挑战性，尤其是在老年患者中。双钢板固定（DP）是一种有助于早期康复并恢复至伤前活动水平的技术。股骨远端置换（DFR）是治疗这些骨折的另一种技术，可能有助于解决诸如相关膝关节骨关节炎、骨质疏松症和严重粉碎性髁部等问题。本研究比较了老年患者股骨远端骨折治疗中DFR和DP的功能及影像学结果。
本随机、对照、干预性研究在一家大学医院进行。共分析了30例股骨远端骨折（AO/OTA 33 A3、33 C）后接受DFR或DP治疗的患者。主要结局指标为膝关节协会评分（KSS），次要结局指标包括术后并发症发生率、膝关节活动范围、再次手术率和手术时间。
除12个月时KSS的膝关节部分（P = 0.03）和12个月时膝关节活动范围（P = 0.001）外，DFR和DP之间未观察到显著差异，这两项均有利于DP。术后并发症（P = 0.06）、再次手术率（P = 1.00）或手术时间（P = 0.06）方面未发现显著差异。
DFR和DP具有可比的功能（KSS）和影像学结果，术后并发症、再次手术率或手术时间无显著差异。
