Centre for Trauma & Joint Reconstruction Surgery, Sushrut Instt of Medical Sciences, Ramdaspeth, Nagpur, India.
All India Institute of Medical Sciences, New Delhi, India, 110029.
Injury. 2024 Jun;55 Suppl 2:111357. doi: 10.1016/j.injury.2024.111357. Epub 2024 Aug 2.
Recent studies report the overall incidence of distal femur fractures as 8.7/100,000/year. This incidence is expected to rise with high energy motor vehicle collisions and elderly osteoporotic fractures in native and prosthetic knees keep increasing. These fractures are more common in males in the younger age spectrum while females predominate for elderly osteoporotic fractures. Surgical treatment is recommended for these fractures to maintain articular congruity, enable early joint motion and assisted ambulation. Over the last two decades, development of minimally invasive and quadriceps sparing surgical approaches, availability of angle stable implants have helped achieve predictable healing and early return to function in these patients. Currently, laterally positioned locked plate is the implant of choice across all fracture patterns. Retrograde with capital implantation of intramedullary nails with provision for multiplanar distal locking is preferred for extra-articular and partial articular fractures. Even with these advancements, nonunion after distal femur fracture fixation can be as high as 19%. Further recent research has helped us understand the biomechanical limitations and healing problems with lateral locked plate fixation and intramedullary nails. This has lead to development of more robust constructs such as nail-plate and double plate constructs aiming for improved construct strength and to minimise failures. Early results with these combination constructs have shown promise in high risk situations such as fractures with extensive metaphyseal fragmentation, osteoporosis and periprosthetic fractures. These constructs however, run the risk of being over stiff and can inhibit healing if not kept balanced. The ideal stiffness that is needed for fracture healing is not clearly known and current research in this domain has lead to the development of smart implants which are expected to evolve and may help improve clinical results in future.
最近的研究报告称，远端股骨骨折的总发病率为 8.7/100,000/年。预计随着高能机动车碰撞和原发性及假体膝关节老年骨质疏松性骨折的增加，这一发病率将会上升。这些骨折在年轻患者中更常见于男性，而在老年骨质疏松性骨折中女性更为常见。为了保持关节的一致性，使关节尽早运动并辅助行走，建议对这些骨折进行手术治疗。在过去的二十年中，微创和股四头肌保留手术方法的发展，以及角度稳定植入物的可用性，有助于实现这些患者可预测的愈合和早期功能恢复。目前，外侧定位锁定板是所有骨折模式的首选植入物。对于关节外和部分关节骨折，逆行带髓内钉并提供多平面远端锁定是首选方法。即使有了这些进步，远端股骨骨折固定后的不愈合率仍高达 19%。最近的进一步研究帮助我们了解了外侧锁定板固定和髓内钉的生物力学限制和愈合问题。这导致了更强大的构建物的发展，如钉板和双板构建物，旨在提高构建物的强度并尽量减少失败。这些组合构建物的早期结果在高风险情况下显示出了希望，例如广泛的干骺端粉碎、骨质疏松症和假体周围骨折。然而，这些构建物存在过度僵硬的风险，如果不保持平衡，可能会抑制愈合。对于骨折愈合所需的理想刚度尚不清楚，目前这一领域的研究导致了智能植入物的发展，预计这些植入物将不断发展，并可能有助于未来改善临床结果。
