The Terrible Triad as a Predictor of Nonunion in Distal Femur Fractures Treated With Lateral Locking Plates: A Retrospective Cohort Study.

IF 1.8 3区医学 Q3 ORTHOPEDICS

Journal of Orthopaedic Trauma Pub Date : 2025-09-30 DOI:10.1097/BOT.0000000000003088

Agraharam Devendra, Asif Imran, Rahul Sutariya, Arunkamal Chandramohan, Purnaganapathi Sundaram Velmurugesan, Perumal Ramesh, Zackariya Mohamed, Jayaramaraju Dheenadhayalan, Shanmuganathan Rajasekaran

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引用次数: 0

Abstract

Objectives: To identify risk factors for nonunion in distal femur fractures (DFFs) treated with lateral locking plates (LLPs).

Methods: Design : Retrospective cohort study.

Setting: Single Level I Trauma Center.

Patient selection criteria: Adult patients with OTA/AO 33A and 33C DFFs treated with LLPs between 2014 and 2019 were included.

Outcome measures and comparisons: Nonunion, defined as the need for a subsequent surgical procedure to promote bone healing, was assessed in relation to patient demographics, comorbidities, injury, and fixation characteristics.

Results: A total of 298 patients (75.5% male; mean age 43.1 ± 13.7 years) were included. Among these, 166 fractures were classified as OTA/AO type 33A and 132 fractures as type 33C. Open fractures were present in 47.7%, and 72.1% had comminuted fractures. Nonunion occurred at 19.1% (57/298). No significant differences in age, sex, BMI, smoking, or diabetes were observed between union and nonunion groups. Multivariable analysis identified open fracture (OR 3.25; 95% CI 2.10-5.02; p < 0.001), comminution (OR 2.85; 95% CI 1.89-4.31; p < 0.001), and medial void >1 cm (OR 4.50; 95% CI 2.80-7.30; p < 0.001) as independent predictors. Fixation characteristics, including plate material, length, screw configuration, and alignment, were not associated with nonunion. A post hoc composite variable, the "Terrible Triad," combining open fracture, comminution, and medial void >1 cm, was associated with a 36.7% nonunion rate compared to 5.9% without the triad (p < 0.001) and remained an independent predictor (OR 6.5; 95% CI 3.3-12.9; p < 0.001).

Conclusions: The distal femur fracture "Terrible Triad" (open fracture, comminution, and medial void >1 cm) was a strong independent predictor of nonunion after lateral locked plating. Lateral locked plating fixation characteristics of were not significantly associated with nonunion. Early recognition and targeted management of triad features may improve healing outcomes.

Level of evidence: Prognostic Level III.

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可怕的三联征作为外侧锁定钢板治疗股骨远端骨折不愈合的预测指标：一项回顾性队列研究。

目的：确定外侧锁定钢板（llp）治疗股骨远端骨折（dff）不愈合的危险因素。方法：设计：回顾性队列研究。地点：一级创伤中心。患者选择标准：纳入2014年至2019年间接受llp治疗的OTA/ ao33a和33C dff的成年患者。结果测量和比较：骨不连，定义为需要后续手术来促进骨愈合，与患者人口统计学、合并症、损伤和固定特征相关。结果：共纳入298例患者，其中男性75.5%，平均年龄43.1±13.7岁。其中，OTA/AO 33A型166条，33C型132条。开放性骨折占47.7%，粉碎性骨折占72.1%。不愈合发生率为19.1%（57/298）。愈合组和不愈合组在年龄、性别、BMI、吸烟或糖尿病方面没有显著差异。多变量分析发现开放性骨折（OR 3.25, 95% CI 2.10-5.02, p < 0.001）、粉碎性骨折（OR 2.85, 95% CI 1.89-4.31, p < 0.001）和内侧空隙bbb1cm （OR 4.50, 95% CI 2.80-7.30, p < 0.001）是独立的预测因素。固定特征，包括钢板材料、长度、螺钉配置和对中，与骨不连无关。一个事后复合变量，“可怕的三联征”，包括开放性骨折、粉碎性骨折和内侧空腔bbb1cm，与36.7%的骨不愈合率相关（p < 0.001），而没有三联征时为5.9% (p < 0.001)，并且仍然是一个独立的预测因子（OR 6.5; 95% CI 3.3-12.9; p < 0.001）。结论：股骨远端骨折“可怕三联征”（开放性骨折、粉碎性骨折和内侧空腔bbb1cm）是外侧锁定钢板后骨不愈合的一个强有力的独立预测指标。侧锁钢板固定特征与骨不连无显著相关性。早期识别和有针对性的管理三联征可以改善愈合结果。证据等级：预后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.