Li Meng, Wu Taoguang, Zhang Zicheng, Ren Xiaomeng, Hu Mengmeng, Zhang Dong, Zhang Wei
Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, China.
Orthop Surg. 2025 Aug;17(8):2435-2444. doi: 10.1111/os.70103. Epub 2025 Jun 26.
Double plate (DP) fixation does not significantly improve outcomes compared to lateral locking plate (LLP-only) fixation for distal femur fractures (DFFs). We hypothesize this is due to the absence of clear indications for the application of these two fixation methods. This study aims to clarify the impact of metaphyseal defect size on the outcomes of these two treatments, in order to optimize surgical efficacy and minimize complications.
We screened patients with distal femoral fractures treated with lateral locking plate or dual plate fixation at our hospital between January 2018 and June 2023 retrospectively. Information such as demographic data, fracture classification, operation details, metaphyseal bone defect size, pre-nd post-operative imaging data, and other medical records were compiled. Additionally, patients' recovery status was follow-up, including evaluation of knee joint function (Lysholm score), range of motion (ROM), and EQ-5D-3L health score. We used diverse statistical methods for further analysis, such as t-test, chi-square test, Pearson correlation coefficients, and binary logistic regression analysis.
According to the specified criteria, 55 distal femur fracture cases were ultimately included, with 38 cases in the LLP-only group and 17 cases in the DP fixation group. In terms of surgical and follow-up information, there were no statistical differences in healing status, but there were statistically significant differences in average blood loss (p = 0.013), metaphyseal bone defect size (p < 0.001), Lysholm score (p = 0.003), and EQ-5D score (p = 0.010). Notably, compared to other parameters, the size of the fracture defect exhibited the highest correlation (0.69) with healing outcomes. In logistic regression analysis, the defect size (OR 1.052, 95% CI 1.008-1.098, p = 0.021) was independently associated with the healing outcome. Upon further analysis, non-healing cases in the LLP-only group were predominantly associated with A3, C2, and C3 type fractures, with 83.3% of these patients presenting metaphyseal defects exceeding 15 mm.
We carried out a comparative evaluation of LLP-only versus DP fixation in addressing DFFs. Our research outcomes revealed that LLP-only fixation yielded notably suboptimal results compared to DP fixation, especially in intricate fractures accompanied by defects, such as those classified under types A3, C2, and C3. Furthermore, the more significant the defect, the less effective the fixation of LLP-only will be. This observation underscores the pivotal role of the scope of metaphysical damage in determining the most suitable internal fixation techniques for DFFs.
对于股骨远端骨折（DFFs），与单纯外侧锁定钢板（LLP）固定相比，双钢板（DP）固定并不能显著改善治疗效果。我们推测这是由于这两种固定方法的应用缺乏明确的指征。本研究旨在阐明干骺端缺损大小对这两种治疗方法疗效的影响，以优化手术效果并减少并发症。
我们回顾性筛选了2018年1月至2023年6月期间在我院接受外侧锁定钢板或双钢板固定治疗的股骨远端骨折患者。收集了人口统计学数据、骨折分类、手术细节、干骺端骨缺损大小、术前和术后影像学数据以及其他病历信息。此外，对患者的恢复状况进行了随访，包括膝关节功能评估（Lysholm评分）、活动范围（ROM）和EQ-5D-3L健康评分。我们使用了多种统计方法进行进一步分析，如t检验、卡方检验、Pearson相关系数和二元逻辑回归分析。
根据指定标准，最终纳入55例股骨远端骨折病例，其中单纯LLP组38例，DP固定组17例。在手术和随访信息方面，愈合状况无统计学差异，但平均失血量（p = 0.013）、干骺端骨缺损大小（p < 0.001）、Lysholm评分（p = 0.003）和EQ-5D评分（p = 0.010）有统计学显著差异。值得注意的是，与其他参数相比，骨折缺损大小与愈合结果的相关性最高（0.69）。在逻辑回归分析中，缺损大小（OR 1.052，95% CI 1.008 - 1.098，p = 0.021）与愈合结果独立相关。进一步分析发现，单纯LLP组的不愈合病例主要与A3、C2和C3型骨折相关，这些患者中有83.3%的干骺端缺损超过15毫米。
我们对单纯LLP与DP固定治疗DFFs进行了比较评估。我们的研究结果表明，与DP固定相比，单纯LLP固定的效果明显欠佳，尤其是在伴有缺损的复杂骨折中，如A3、C2和C3型骨折。此外，缺损越严重，单纯LLP固定的效果越差。这一观察结果强调了干骺端损伤范围在确定DFFs最合适的内固定技术方面的关键作用。
