Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated With Lateral Locked Plating: A Risk-Stratified Analysis.

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2024-01-01 DOI:10.1097/BOT.0000000000002680

David J Stockton, Nathan N O'Hara, Dane J Brodke, Natasha McKibben, Kathleen Healey, Abraham Goch, Haley Demyanovich, Sai Devana, Adolfo Hernandez, Cynthia E Burke, Jayesh Gupta, Lucas S Marchand, Graham J Dekeyser, Lillia Steffenson, Stephen J Shymon, Marshall J Fairres, Paul W Perdue, Colby Barber, Omar H Atassi, Thomas W Mitchell, Zachary M Working, Loren O Black, Ashraf N El Naga, Erika Roddy, Matthew Hogue, Trevor Gulbrandsen, John Morellato, W Hunter Gillon, Murphy M Walters, Eric Hempen, Gerard P Slobogean, Christopher Lee, Robert V O'Toole

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引用次数: 0

Abstract

Objective: To identify technical factors associated with nonunion after operative treatment with lateral locked plating.

Methods:

Design: Retrospective cohort study.

Setting: Ten Level I trauma centers.

Patient selection criteria: Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019.

Outcome measures and comparisons: Surgery for nonunion stratified by risk for nonunion.

Results: The cohort included 615 patients with supracondylar distal femur fractures. The median patient age was 61 years old (interquartile range: 46 -72years) and 375 (61%) were female. Observed were nonunion rates of 2% in a low risk of nonunion group (n = 129), 4% in a medium-risk group (n = 333), and 14% in a high-risk group (n = 153). Varus malreduction with an anatomic lateral distal femoral angle greater than 84 degrees, was associated with double the odds of nonunion compared to those without such varus [odds ratio, 2.1; 95% confidence interval (CI), 1.1-4.2; P = 0.03]. Malreduction by medial translation of the articular block increased the odds of nonunion, with 30% increased odds per 4 mm of medial translation (95% CI, 1.0-1.6; P = 0.03). Working length increased the odds of nonunion in the medium risk group, with an 18% increase in nonunion per 10-mm increase in working length (95% CI, 1.0-1.4; P = 0.01). Increased proximal screw density was protective against nonunion (odds ratio, 0.71; 95% CI, 0.53-0.92; P = 0.02) but yielded lower mRUST scores with each 0.1 increase in screw density associated with a 0.4-point lower mRUST (95% CI, -0.55 to -0.15; P < 0.001). Lateral plate length and type of plate material were not associated with nonunion. ( P > 0.05).

Conclusions: Malreduction is a surgeon-controlled variable associated with nonunion after lateral locked plating of supracondylar distal femur fractures. Longer working lengths were associated with nonunion, suggesting that bridge plating may be less likely to succeed for longer fractures.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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采用外侧锁定钢板治疗股骨髁上远端骨折导致不愈合的技术因素：风险分层分析

目的确定与侧方锁定钢板手术治疗后不愈合相关的技术因素：设计设计：回顾性队列研究：十家一级创伤中心：2010年至2019年期间接受外侧锁定钢板治疗的股骨远端髁上骨折（OTA/AO 33A或C型）成人患者：结果：队列中包括615名股骨髁上远端骨折（OTA/AO 33A或C型）患者：队列包括615名股骨远端髁上骨折患者。患者年龄中位数为61岁（四分位间范围：46 -72岁），其中375人（61%）为女性。观察到的不愈合率为：低风险组（129 人）2%，中风险组（333 人）4%，高风险组（153 人）14%。股骨远端外侧解剖角度大于84度的股骨外侧曲度缩小不良与发生非髋关节畸形的几率是没有这种曲度的两倍[几率比，2.1；95%置信区间（CI），1.1-4.2；P = 0.03]。关节块内侧移位造成的误收增加了发生骨不连的几率，内侧移位每增加4毫米，发生骨不连的几率增加30%（95% CI，1.0-1.6；P = 0.03）。工作长度增加了中度风险组的骨不连几率，工作长度每增加 10 毫米，骨不连几率增加 18% (95% CI, 1.0-1.4; P = 0.01)。增加近端螺钉密度可防止骨不连（几率比为 0.71；95% CI 为 0.53-0.92；P = 0.02），但会降低 mRUST 评分，螺钉密度每增加 0.1，mRUST 评分就会降低 0.4 分（95% CI 为-0.55--0.15；P < 0.001）。侧板长度和钢板材料类型与骨不连无关。(P>0.05）：结论：股骨髁上远端骨折侧位锁定钢板术后，骨折复位不良是一个由外科医生控制的与骨折不愈合相关的变量。较长的工作长度与骨折不愈合有关，这表明对于较长的骨折，桥接复位可能不太容易成功：证据等级：治疗三级。有关证据级别的完整描述，请参阅 "作者须知"。

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来源期刊

Journal of Orthopaedic Trauma 医学-运动科学

CiteScore

3.90

自引率

8.70%

发文量

396

审稿时长

3-8 weeks

期刊介绍： Journal of Orthopaedic Trauma is devoted exclusively to the diagnosis and management of hard and soft tissue trauma, including injuries to bone, muscle, ligament, and tendons, as well as spinal cord injuries. Under the guidance of a distinguished international board of editors, the journal provides the most current information on diagnostic techniques, new and improved surgical instruments and procedures, surgical implants and prosthetic devices, bioplastics and biometals; and physical therapy and rehabilitation.