Kriechling Philipp, Bowley Abigail L W, Ross Lauren A, Moran Matthew, Scott Chloe E H
Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
Department of Orthopaedics, University of Edinburgh, Edinburgh, UK.
Bone Jt Open. 2024 Jun 12;5(6):489-498. doi: 10.1302/2633-1462.56.BJO-2023-0145.R1.
The purpose of this study was to compare reoperation and revision rates of double plating (DP), single plating using a lateral locking plate (SP), or distal femoral arthroplasty (DFA) for the treatment of periprosthetic distal femur fractures (PDFFs).
All patients with PDFF primarily treated with DP, SP, or DFA between 2008 and 2022 at a university teaching hospital were included in this retrospective cohort study. The primary outcome was revision surgery for failure following DP, SP, or DFA. Secondary outcome measures included any reoperation, length of hospital stay, and mortality. All basic demographic and relevant implant and injury details were collected. Radiological analysis included fracture classification and evaluation of metaphyseal and medial comminution.
A total of 111 PDFFs (111 patients, median age 82 years (interquartile range (IQR) 75 to 88), 86% female) with 32 (29%) Su classification 1, 37 (34%) Su 2, and 40 (37%) Su 3 fractures were included. The median follow-up was 2.5 years (IQR 1.2 to 5.0). DP, SP, and DFA were used in 15, 66, and 30 patients, respectively. Compared to SP, patients treated with DP were more likely to have metaphyseal comminution (47% vs 14%; p = 0.009), to be low fractures (47% vs 11%; p = 0.009), and to be anatomically reduced (100% vs 71%; p = 0.030). Patients selected for DFA displayed comparable amounts of medial/metaphyseal comminution as those who underwent DP. At a minimum follow-up of two years, revision surgery for failure was performed in 11 (9.9%) cases at a median of five months (IQR 2 to 9): 0 DP patients (0%), 9 SP (14%), and 2 DFA (6.7%) (p = 0.249).
Using a strategy of DP fixation in fractures, where the fracture was low but there was enough distal bone to accommodate locking screws, and where there is metaphyseal comminution, resulted in equivalent survival free from revision or reoperation compared to DFA and SP fixation.
本研究旨在比较双钢板固定（DP）、使用外侧锁定钢板的单钢板固定（SP）或股骨远端关节成形术（DFA）治疗股骨假体周围远端骨折（PDFF）的再次手术率和翻修率。
本回顾性队列研究纳入了2008年至2022年期间在一所大学教学医院接受DP、SP或DFA初步治疗的所有PDFF患者。主要结局是DP、SP或DFA失败后的翻修手术。次要结局指标包括任何再次手术、住院时间和死亡率。收集了所有基本人口统计学资料以及相关植入物和损伤细节。影像学分析包括骨折分类以及干骺端和内侧粉碎情况的评估。
共纳入111例PDFF（111例患者，中位年龄82岁（四分位间距（IQR）75至88岁），86%为女性），其中32例（29%）为苏（Su）分类1型骨折，37例（34%）为Su 2型骨折，40例（37%）为Su 3型骨折。中位随访时间为2.5年（IQR 1.2至5.0）。分别有15例、66例和30例患者使用了DP、SP和DFA。与SP相比，接受DP治疗的患者更易出现干骺端粉碎（47%对14%；p = 0.009）、低位骨折（47%对11%；p = 0.009）以及解剖复位（100%对71%；p = 0.030）。选择DFA治疗的患者其内侧/干骺端粉碎程度与接受DP治疗的患者相当。在至少两年的随访中，11例（9.9%）患者因失败接受了翻修手术，中位时间为5个月（IQR 2至9）：0例DP患者（0%）、9例SP患者（14%）和2例DFA患者（6.7%）（p = 0.249）。
对于骨折位置低但有足够远侧骨来容纳锁定螺钉且存在干骺端粉碎的骨折，采用DP固定策略与DFA和SP固定相比，在无需翻修或再次手术方面具有相同的生存率。
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