Interprosthetic Femur Fractures: A Multi-Center Retrospective Study.

IF 1.6 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2025-05-06 DOI:10.1097/BOT.0000000000003003

Samuel Landoch, Jeffrey A Foster, Lisa K Cannada, William T Obremskey, Ryan Will, Brianna Fram, Simon C Mears, Jeffrey B Stambough, Benjamin M Stronach, Harrison Brown, Jason J Halvorson, Nicholas Andring, Natalie Marenghi, Niloofar Dehghan, Tony Huynh, Scott Ryan, Guy Guenthner, Aaron Shiinoki, Jacob M Fischman, Elsa Rodriguez, Andres F Moreno-Diaz, Aleksander Mika, Farhan Chowdry, Andrew Chen, Zohair Zaidi, Anna N Miller, Joseph Gutbrod, Erin Hofer, Carmen Quatman, Jarrod Dumpe, Marek Denisiuk, Marylou Sutherland, Heidi Israel, Paul E Matuszewski, Arun Aneja

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引用次数: 0

Abstract

Objectives: To identify practices for treating interprosthetic femur fracture (IFFs) and determine factors that positively impact patient outcomes.

Methods: Design: Retrospective cohort study.

Setting: Fifteen trauma centers in the United States.

Patient selection criteria: Patients aged 50 to 90 years who underwent operative fixation of an AO/OTA 32 A-B-C type IFF fracture from 2011 to 2021 were included. Patients who underwent revision arthroplasty at the time of fixation or were non-ambulatory were excluded.

Outcome measures and comparisons: The primary outcome was union rate. Secondary outcomes included post-operative complications, revision surgery, mortality, and change in ambulation status. Univariate analyses using Chi-square tests, Fisher's exact tests, and analysis of variance were performed to detect associations between demographic, injury, and surgical characteristics with post-operative outcomes.

Results: One hundred thirty-nine patients were included, with 110 (79%) females and median age 78 [range, 57-90]. Distal one-third fractures were most common 68% (N=95). One hundred eighteen (85%) patients were treated with a lateral plate, 8% (N=11) were treated with nail-plate combination and 7% (N=10) were treated with dual plates. The median time to full-weight bearing (FWB) was 2.5 months. Dual plate combination was associated with the fastest time to FWB (p = 0.048) at two weeks. 61% (n=85) of patients returned to baseline ambulation status (100% [11] IMN/plate, 60% [71] lateral plate and 25% [3] dual plate) with patients treated with nail-plate had higher rates of return to baseline function (p = 0.009). The overall mortality rate was 13% and associated with greater than 1 comorbidity (p = 0.022).

Conclusions: A spanning lateral plate was the most common fixation of IFF in our study. Patients with dual fixation were more likely to return to baseline ambulatory status, particularly those with intramedullary nail/plate combination. The mortality rate at one year was 11% and comorbidity burden was associated with higher risk of mortality.

Level of evidence: Therapeutic Level III.

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股骨假体间骨折：一项多中心回顾性研究。

目的：确定治疗假体间股骨骨折（IFFs）的方法，并确定对患者预后有积极影响的因素。方法：设计：回顾性队列研究。背景：美国有15个创伤中心。患者选择标准：纳入2011 - 2021年间接受AO/OTA 32 A-B-C型IFF骨折手术固定的患者，年龄50 - 90岁。在固定时接受翻修关节置换术或不活动的患者被排除在外。结果测量和比较：主要结果为结合力。次要结局包括术后并发症、翻修手术、死亡率和活动状态的改变。采用卡方检验、Fisher精确检验和方差分析进行单因素分析，以检测人口统计学、损伤和手术特征与术后结局之间的关系。结果：纳入139例患者，其中女性110例（79%），中位年龄78岁[范围，57-90]。三分之一的远端骨折最为常见，占68% （N=95）。118例（85%）采用侧钢板治疗，8% （N=11）采用甲钢板联合治疗，7% （N=10）采用双钢板治疗。到全体重（FWB）的中位时间为2.5个月。双板组合与两周时最快的FWB时间相关（p = 0.048）。61% （n=85）的患者恢复到基线活动状态（100% [11]IMN/钢板，60%[71]侧钢板和25%[3]双钢板），而接受钉钢板治疗的患者恢复基线功能的比率更高（p = 0.009）。总死亡率为13%，并伴有1个以上的合并症（p = 0.022）。结论：在我们的研究中，跨侧钢板是IFF最常见的固定。双重内固定的患者更有可能恢复到基线的活动状态，特别是那些髓内钉/钢板联合的患者。1年死亡率为11%，合并症负担与较高的死亡风险相关。证据等级：治疗性III级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.