Fujita Kentaro, Fujita Kenji, Kamata Daiki, Yasutake Hidetoshi, Demura Satoru
Department of Orthopaedic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, JPN.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, JPN.
Cureus. 2024 Jul 20;16(7):e65006. doi: 10.7759/cureus.65006. eCollection 2024 Jul.
Distal femoral fractures are commonly treated with osteosynthesis. However, in older patients with osteoarthritis of the knee, acute primary total knee arthroplasty (TKA) may be performed to treat these fractures. Notably, no studies have documented the use of osteosynthesis in combination with distal femoral osteotomy (DFO) for treating distal femoral fractures in patients with knee osteoarthritis. This report presents the case of a 66-year-old woman with lateral compartment osteoarthritis accompanied by severe valgus knee deformity who underwent osteosynthesis for a distal femoral fracture combined with medial closing-wedge distal femoral osteotomy (MCWDFO) to correct the knee valgus deformity. She experienced a distal femoral fracture (AO/OTA 33B1.1) of the right knee because of a fall. Before the injury, she exhibited a limp due to severe knee pain with some limitations in knee flexion. Non-weight-bearing radiographs of the entire lower extremity suggested a percentage mechanical axis (%MA) of 115%, indicating severe valgus deformity. On day nine after the injury, we performed osteosynthesis for the distal femoral fracture and conducted an MCWDFO to correct the right knee valgus deformity. After MCWDFO, the %MA was corrected to 70%. Partial weight-bearing was initiated three weeks postoperatively and progressed to full weight-bearing at six weeks. To facilitate bone healing, low-intensity pulsed ultrasound (LIPUS) was applied for three months after surgery. Bone union was successfully achieved by month five. Some medial knee pain persisted for six months after surgery; nonetheless, the patient could walk without a limp. We considered that the integration of MCWDFO with osteosynthesis could provide a treatment option for patients with distal femoral fractures and lateral compartment osteoarthritis.
股骨远端骨折通常采用接骨术治疗。然而，对于患有膝关节骨关节炎的老年患者，可进行急性一期全膝关节置换术（TKA）来治疗这些骨折。值得注意的是，尚无研究记录使用接骨术联合股骨远端截骨术（DFO）治疗膝关节骨关节炎患者的股骨远端骨折。本报告介绍了一例66岁女性患者的病例，该患者患有外侧间室骨关节炎并伴有严重膝外翻畸形，因跌倒导致右膝股骨远端骨折，接受了股骨远端骨折接骨术并联合内侧闭合楔形股骨远端截骨术（MCWDFO）以纠正膝外翻畸形。她因跌倒导致右膝股骨远端骨折（AO/OTA 33B1.1）。受伤前，她因严重的膝关节疼痛而跛行，膝关节屈曲也有一定限制。整个下肢的非负重X线片显示机械轴百分比（%MA）为115%，表明存在严重的外翻畸形。受伤后第9天，我们对股骨远端骨折进行了接骨术，并进行了MCWDFO以纠正右膝外翻畸形。MCWDFO后，%MA校正至70%。术后三周开始部分负重，六周时进展为完全负重。为促进骨愈合，术后三个月应用了低强度脉冲超声（LIPUS）。术后五个月成功实现了骨愈合。术后六个月膝关节内侧仍有一些疼痛；尽管如此，患者可以正常行走而无跛行。我们认为，MCWDFO与接骨术相结合可为股骨远端骨折合并外侧间室骨关节炎的患者提供一种治疗选择。
