Peterson Asa, Nwadike Benjamin, Headford Mikel, Revak Thomas
Department of Orthopaedic Surgery, Center for Specialized Medicine, St. Louis University Hospital, St. Louis, MO.
La Crosse-Orthopedics, La Crosse, WI.
OTA Int. 2025 May 29;8(2):e399. doi: 10.1097/OI9.0000000000000399. eCollection 2025 Jun.
Multiple treatment modalities exist for treating distal femur fractures. Lateral locked plating has become the method of choice because it prevents loss of reduction due to varus collapse, but has been associated with nonunion rates of up to 30%. Titanium implants may provide a more optimal biomechanical environment for fracture healing. The primary aim of this study is to evaluate nonunion rates and risk factors for nonunion in a series of distal femur fractures stabilized with modern locked titanium implants using all nonlocking diaphyseal fixation. A secondary aim is to evaluate whether diaphyseal fixation with nonlocking screws is associated with fixation complications.
A 6-year retrospective study identified patients undergoing operative fixation of distal femur fractures with lateral locked plating and nonlocking diaphyseal fixation. Patient demographics, fracture and fixation characteristics were recorded. Follow-up data recorded included fracture union, implant failure in the setting of nonunion and secondary procedures. Statistical analyses used include test, Mann-Whitney , and logistic regression.
Eighty-one fractures met inclusion criteria with 16 fractures resulting in nonunion (19.75%). Comparing union and nonunion cohorts, nonunions were found to be associated with higher body mass index ( = 0.001). Fixation construct data found nonunions had a higher average number of diaphyseal screws (4.25 vs. 3.74, = 0.038). Subgroup analysis found a nonunion rate of 4.2% (1 out of 24) in fractures with 3 diaphyseal screw fixation versus 26.3% (15 out of 57) with 4 or more diaphyseal screws ( = 0.038). No diaphyseal fixation failures were noted with nonlocking diaphyseal screw fixation.
Our study found using a titanium construct produced a nonunion rate of 19.75%, comparable with historic rates. Interestingly, diaphyseal fixation with more than 3 screws led to higher nonunion rates. No catastrophic failures were observed involving the diaphyseal nonlocking screw fixation.
治疗股骨远端骨折有多种治疗方式。外侧锁定钢板固定已成为首选方法，因为它可防止因内翻塌陷导致复位丢失，但骨不连发生率高达30%。钛植入物可能为骨折愈合提供更理想的生物力学环境。本研究的主要目的是评估一系列使用全非锁定骨干固定的现代锁定钛植入物固定的股骨远端骨折的骨不连发生率及骨不连的危险因素。次要目的是评估非锁定螺钉骨干固定是否与固定并发症相关。
一项为期6年的回顾性研究确定了接受股骨远端骨折外侧锁定钢板及非锁定骨干固定手术的患者。记录患者人口统计学资料、骨折及固定特征。记录的随访数据包括骨折愈合情况、骨不连情况下的植入物失败及二次手术情况。使用的统计分析方法包括检验、曼-惠特尼检验和逻辑回归。
81例骨折符合纳入标准，16例骨折发生骨不连（19.75%）。比较愈合组和骨不连组，发现骨不连与更高的体重指数相关（P = 0.001）。固定结构数据显示，骨不连的骨干螺钉平均数量更多（4.25枚对3.74枚，P = 0.038）。亚组分析发现，3枚骨干螺钉固定的骨折骨不连发生率为4.2%（24例中的1例），而4枚或更多骨干螺钉固定的骨折骨不连发生率为26.3%（57例中的15例）（P = 0.038）。非锁定骨干螺钉固定未发现骨干固定失败情况。
我们的研究发现，使用钛固定结构的骨不连发生率为19.75%，与既往发生率相当。有趣的是，3枚以上螺钉的骨干固定导致更高的骨不连发生率。未观察到涉及骨干非锁定螺钉固定的灾难性失败情况。
