Harbor-UCLA Medical Center, Torrance, CA.
University of California, Los Angeles, CA.
J Orthop Trauma. 2024 May 1;38(5):273-278. doi: 10.1097/BOT.0000000000002779.
To identify risk factors of reoperation to promote union or to address deep surgical-site infection (DSSI) in periprosthetic distal femur fractures treated with lateral distal femoral locking plates (LDFLPs).
Multicenter retrospective cohort study.
Ten level-I trauma centers.
Patients with Orthopaedic Trauma Association/Association of Osteosynthesis (OTA/AO) 33A or 33C periprosthetic distal femur fractures who underwent surgical fixation between January 2012 and December 2019 exclusively using LDFLPs were eligible for inclusion. Patients with pathologic fractures or with follow-up less than 3 months without an outcome event (unplanned reoperation to promote union or for deep surgical infection) before this time point were excluded. Fracture fixation constructs used medial plates, intramedullary nails, or hybrid fixation constructs were excluded from analysis.
To examine the influence of patient demographics, injury characteristics, and features of the fracture fixation construct on the occurrence of unplanned reoperation to promote union or to address a DSSI.
There was an 8.3% rate (19/228) of unplanned reoperation to promote union. Predictive factors for the need for reoperation to promote union included increasing body mass index (odds ratio [OR] = 1.09; 95% confidence interval [CI]: 1.02-1.16; P = 0.01), increasing number of screws in the distal fracture segment (OR = 1.73; 95% CI: 1.06-2.95; P = 0.03), and decreasing proportion of proximal segment screws that are locking (OR = 0.17; 95% CI: 0.03-0.70; P = 0.02) There was a 4.8% rate (11/228) of reoperation to address DSSI. There were no statistically significant predictive factors identified as risk factors of the need for reoperation to address DSSI ( P > 0.05).
8.3% of periprosthetic distal femur fractures treated at 10 centers with LDFLPs underwent unplanned reoperation to promote union. Increasing patient body mass index and increasing number of screws in the distal fracture segment were found to be predictive factors, whereas increased locking screws in the proximal segment were found to be protective. 4.8% of patients in this cohort underwent reoperation to address DSSI.
Level III. See Instructions for Authors for a complete description of levels of evidence.
确定再次手术的风险因素，以促进愈合或解决假体周围股骨远端骨折中深部手术部位感染（DSSI）。
多中心回顾性队列研究。
10 个一级创伤中心。
2012 年 1 月至 2019 年 12 月期间，仅使用外侧股骨远端锁定钢板（LDFLP）治疗的，接受手术固定的，伴有骨关节炎/骨外科学会（OTA/AO）33A 或 33C 假体周围股骨远端骨折的患者。排除病理性骨折或随访时间少于 3 个月且在该时间点之前没有计划再次手术（促进愈合或深部手术感染）的患者。排除使用内侧钢板、髓内钉或混合固定的骨折固定结构。
检查患者人口统计学、损伤特征和骨折固定结构特征对计划外再次手术以促进愈合或解决深部手术感染的影响。
有 8.3%（19/228）的患者需要再次手术以促进愈合。需要再次手术以促进愈合的预测因素包括体重指数增加（比值比[OR] = 1.09；95%置信区间[CI]：1.02-1.16；P = 0.01）、远端骨折段螺钉数量增加（OR = 1.73；95%CI：1.06-2.95；P = 0.03）和近端段锁定螺钉比例降低（OR = 0.17；95%CI：0.03-0.70；P = 0.02）。有 4.8%（11/228）的患者需要再次手术以解决 DSSI。没有发现统计学上显著的预测因素可作为需要再次手术解决 DSSI 的危险因素（P > 0.05）。
10 个中心使用 LDFLP 治疗的假体周围股骨远端骨折中有 8.3%的患者需要计划外再次手术以促进愈合。发现患者体重指数增加和远端骨折段螺钉数量增加是预测因素，而近端段锁定螺钉增加则具有保护作用。该队列中有 4.8%的患者需要再次手术以解决 DSSI。
三级。有关证据水平的完整描述，请参阅作者说明。
