De Mauro Domenico, Smakaj Amarildo, Casiraghi Alessandro, Galante Claudio, Bove Federico, Arduini Mario, Vicenti Giovanni, Addevico Francesco, Fratus Abramo, Macellari Nicola, Caredda Matteo, Buono Claudio, Maccauro Giulio, Rovere Giuseppe, Liuzza Francesco
Department of Orthopedics, Ageing and Rheumatological Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy.
Department of Orthopedics and Geriatrics Sciences, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 8, 00168, Rome, Italy.
J Orthop Traumatol. 2025 Apr 2;26(1):22. doi: 10.1186/s10195-025-00834-1.
Distal femur fractures present a significant challenge for orthopedic surgeons, accounting for approximately 5% of all femoral fractures. Among the most commonly reported combined techniques in the literature are the double-plate technique and the retrograde nailing plus lateral plating, the nail-plate construct (NPC). The aim of our study is to compare surgical data, quality of life, and functional outcomes in 33-C fractures treated with either double-plate constructs or a retrograde nailing plus lateral plate.
A multicenter retrospective observational study was conducted in accordance with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Diagnoses were made on the basis of the AO classification, utilizing traditional radiological assessments. Patients were categorized into two groups on the basis of the surgical treatment they received: The NPC group comprised patients who underwent surgery with nail-plate construct, while the Plate group consisted of those who had surgery with double plating.
A total of 42 patients were included in the study. The NPC group comprised 26 patients with a mean age of 58.4 ± 18.8 years, while the Plate group consisted of 16 patients with a mean age of 61.3 ± 16.4 years. Significant differences were observed in knee extension recovery (p = 0.010) and lateral distal femur angle (LDFA) (p < 0.001). Linear regression showed a significant influence from treatment choice on all the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, as well as in all domains of the European Quality of Life Five Dimensions Five-Level Version (EQ-5D-5L), except for the Daily Self-Care domain.
Nail-plate constructs seems to lead to significantly better outcomes in AO type C distal femur fractures, compared with double plating, in terms of knee function and quality of life. Significant differences are shown also in anatomical outcomes, especially in extension gap, and LDFA.
III.
股骨远端骨折给骨科医生带来了重大挑战，约占所有股骨骨折的5%。文献中最常报道的联合技术包括双钢板技术、逆行髓内钉加外侧钢板固定，即钉板结构（NPC）。本研究的目的是比较采用双钢板结构或逆行髓内钉加外侧钢板治疗33 - C型骨折的手术数据、生活质量和功能结局。
按照加强流行病学观察性研究报告（STROBE）指南进行了一项多中心回顾性观察研究。诊断依据AO分类，采用传统放射学评估方法。根据患者接受的手术治疗将其分为两组：NPC组包括接受钉板结构手术的患者，而钢板组由接受双钢板手术的患者组成。
本研究共纳入42例患者。NPC组有26例患者，平均年龄为58.4±18.8岁，而钢板组有16例患者，平均年龄为61.3±16.4岁。在膝关节伸展恢复情况（p = 0.010）和股骨远端外侧角（LDFA）（p < 0.001）方面观察到显著差异。线性回归显示，治疗选择对所有膝关节损伤和骨关节炎疗效评分（KOOS）子量表以及欧洲生活质量五维度五级量表（EQ - 5D - 5L）的所有领域均有显著影响，但日常生活自理领域除外。
在AO C型股骨远端骨折中，与双钢板固定相比，钉板结构在膝关节功能和生活质量方面似乎能带来明显更好的结局。在解剖学结局方面也显示出显著差异，尤其是在伸展间隙和LDFA方面。
III级
