Schlauch Adam Michael, Shah Ishan, Crawford Benjamin, Martin Anna, Denisov Anton, Tamer Pierre, Farrell Brian
San Francisco Orthopaedic Residency Program, San Francisco, United States.
Traumatología Elgeadi/Hospital, Madrid, Spain.
Eur J Orthop Surg Traumatol. 2025 Jun 8;35(1):239. doi: 10.1007/s00590-025-04362-w.
To determine the risk factors for reoperation to promote union for periprosthetic distal femur fractures (PDFF).
This was a retrospective, multi-centered comparative study of patients with PDFF (AO 33A-C[VB1, C1, D1]) managed operatively with open reduction and internal fixation (ORIF) with a lateral locked plate (LLP). Exclusion criteria were acute management with a distal femur replacement, fixation other than LLP, less than 6 months of follow-up, and lack of injury or follow-up radiographs. The primary outcome measure was reoperation to achieve bony union. Univariate and multivariate analyses were made between cases that did and did not require a reoperation to achieve union.
A total of 52 patients met inclusion criteria, of which 7 (13.5%) required a reoperation for union. There were no differences between the groups for age, sex, body mass index, comorbidities, Su classification, or open injury. Multivariate analysis identified risks for reoperation to promote union including notching preoperatively (OR 1.26, CI 1.04-1.53, p = 0.007), increased number of screws through a fracture line (OR 1.27, CI 1.15-1.41, p < 0.001), plate length < 12 holes (OR 1.15, CI 1.00-1.33, p = 0.020), and lower number of proximal screws that were locking (OR 0.95, CI 0.9-1.0, p = 0.043). Conclusions The reoperation rate to promote union was 13.5%. While limited by total case number, this study identified notching preoperatively, presence of screws through the fracture line, plate length < 12 holes, and lower number of proximal screws that were locking to be independent risk factors for reoperation to promote union.
确定促进人工关节周围股骨远端骨折（PDFF）愈合的再次手术风险因素。
这是一项回顾性、多中心比较研究，研究对象为接受切开复位内固定（ORIF）联合外侧锁定钢板（LLP）手术治疗的PDFF患者（AO 33A-C[VB1、C1、D1]）。排除标准包括股骨远端置换的急性处理、LLP以外的固定方式、随访时间少于6个月以及缺乏损伤或随访X线片。主要结局指标是为实现骨愈合而进行的再次手术。对需要再次手术以实现愈合和不需要再次手术的病例进行单因素和多因素分析。
共有52例患者符合纳入标准，其中7例（13.5%）需要再次手术以实现愈合。两组在年龄、性别、体重指数、合并症、Su分类或开放性损伤方面无差异。多因素分析确定了促进愈合的再次手术风险因素，包括术前有切迹（OR 1.26，CI 1.04-1.53，p = 0.007）、穿过骨折线的螺钉数量增加（OR 1.27，CI 1.15-1.41，p < 0.001）、钢板长度<12孔（OR 1.15，CI 1,00-1.33，p = 0.020）以及近端锁定螺钉数量较少（OR 0.95，CI 0.9-1.0，p = 0.043）。结论促进愈合的再次手术率为13.5%。虽然受病例总数限制，但本研究确定术前有切迹、穿过骨折线的螺钉存在、钢板长度<12孔以及近端锁定螺钉数量较少是促进愈合的再次手术的独立风险因素。
