Paulsson Martin, Ekholm Carl, Rolfson Ola, Tranberg Roy, Geijer Mats
Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Geriatr Orthop Surg Rehabil. 2024 Oct 7;15:21514593241280914. doi: 10.1177/21514593241280914. eCollection 2024.
Surgical treatment of distal femoral fractures (DFFs) in osteoporotic bone is challenging despite improvements in hardware and surgical techniques. The occurrence and degree of secondary displacement during healing after bridging plate fixation are still unknown. This study aimed to assess the occurrence and degree of secondary displacement in healing DFFs in elderly patients and correlate the secondary displacement to body mass index, bone density, and weight-bearing regimen.
The study involved 32 patients, 65 years or older, with a DFF of AO/OTA types 33 A2-3, B1-2, C1-2, and 32(c) A-C,1-3, including peri-prosthetic fractures with stable implants. Twenty-seven patients had at least 8 weeks of follow-up, and 21 patients had a complete 1-year follow-up. Minimally invasive surgery was performed using a distal anatomical femoral plate as a long bridge-plating construct. Secondary displacement was assessed with computed tomography of the entire femur postoperatively and at 8, 16, and 52 weeks. Femoral length, coronal angulation (varus/valgus), and subsidence as the change in distance between the distal joint surface and a specified locking screw were measured.
There was a statistically significant mean femoral shortening at 52 weeks of 4.7 mm (SD 3.9, (95% CI 2.9-6.5), < 0.001) mainly by subsidence of the distal fragment. Most patients experienced limited coronal angulation. There was no correlation between body mass index or bone density and secondary displacement. At the 1-year follow-up, no patient needed revision surgery for non-union or plate breakage. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or adverse events such as cut-outs.
Modern dynamic plate osteosynthesis could not prevent commonly occurring fracture subsidence in DFF in an elderly cohort. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or mechanical adverse events.
尽管硬件和手术技术有所改进，但骨质疏松性骨的股骨远端骨折（DFF）的手术治疗仍具有挑战性。桥接钢板固定后愈合过程中二次移位的发生率和程度仍不清楚。本研究旨在评估老年患者愈合过程中DFF的二次移位发生率和程度，并将二次移位与体重指数、骨密度和负重方案相关联。
本研究纳入了32例65岁及以上的患者，其DFF为AO/OTA 33 A2-3、B1-2、C1-2型和32(c) A-C、1-3型，包括假体周围骨折且植入物稳定。27例患者至少随访8周，21例患者完成了1年的随访。采用远端解剖型股骨钢板作为长桥接钢板结构进行微创手术。术后以及术后8周、16周和52周通过全股骨计算机断层扫描评估二次移位情况。测量股骨长度、冠状角（内翻/外翻）以及远端关节面与特定锁定螺钉之间距离变化所代表的下沉情况。
在52周时，平均股骨缩短4.7毫米具有统计学意义（标准差3.9，9（5%置信区间2.9-6.5），P<0.001），主要是由于远端骨折块下沉。大多数患者冠状角变化有限。体重指数或骨密度与二次移位之间无相关性。在1年随访时，没有患者因骨不连或钢板断裂需要翻修手术。8周的限制负重并不能防止二次移位或诸如螺钉穿出等不良事件。
现代动力钢板接骨术无法防止老年人群中DFF常见的骨折下沉。8周的限制负重并不能防止二次移位或机械性不良事件。
