Chee Brian R K, Wu Chenghan, Salunke Abhjeet A, Chen Yongsheng
Department of Orthopaedic Surgery, Ng Teng Fong General Hospital, Singapore.
National Healthcare Group, Singapore.
Biomedicine (Taipei). 2025 Mar 1;15(1):57-64. doi: 10.37796/2211-8039.1642. eCollection 2025.
Distal femur fractures result in high morbidity and mortality - comparable to that of hip fractures. The commonly used surgical fixation techniques today, locked plating and intramedullary nailing, have shown high postoperative complication rates. Thus, many surgeons temporarily keep patients non-weight bearing in the early postoperative stage. Increased time to ambulation after surgery is known to increase systemic complications in patients. We aim to investigate if an augmented fixation technique involving the use of a fibular strut allograft with dual locking plates helps to allow early mobilization postoperatively without adverse outcomes.
Five geriatric patients (four female, one male) with distal femur fractures (native or periprosthetic) were treated in our institution with the aforementioned technique, and were allowed early postoperative weight-bearing. These patients were followed up for postoperative outcomes. The primary outcomes studied were non union, implant failure and wound complications. Secondary outcomes studied include time to union, and Sander's functional score.
There were no cases of non-union, implant failure or wound related infection. All patients achieved radiological union (mean = 12.6 weeks). Using Sander's functional scoring, two patients achieved excellent, two achieved good and one had fair outcomes. All patients were followed up for at least 6 months after operation.
Our method of augmented fixation with fibular strut allografts potentially allows for early weight bearing without adverse outcomes. Further studies with larger sample sizes are required to validate our findings.
股骨远端骨折导致的高发病率和死亡率与髋部骨折相当。当今常用的手术固定技术，即锁定钢板固定和髓内钉固定，已显示出较高的术后并发症发生率。因此，许多外科医生在术后早期让患者暂时不负重。众所周知，术后行走时间延长会增加患者的全身并发症。我们旨在研究一种增强固定技术，即使用带双锁定钢板的腓骨支撑异体骨移植，是否有助于术后早期活动且无不良后果。
我们机构对5例股骨远端骨折（原发或假体周围骨折）的老年患者（4例女性，1例男性）采用上述技术进行治疗，并允许患者术后早期负重。对这些患者进行术后结果随访。研究的主要结果是非愈合、植入物失败和伤口并发症。研究的次要结果包括愈合时间和桑德功能评分。
没有出现骨不连、植入物失败或伤口相关感染的病例。所有患者均实现了影像学愈合（平均 = 12.6周）。根据桑德功能评分，2例患者结果为优，2例为良，1例为尚可。所有患者术后均随访至少6个月。
我们采用腓骨支撑异体骨移植的增强固定方法可能允许早期负重且无不良后果。需要进一步进行更大样本量的研究来验证我们的发现。
