Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures.

IF 4.1 Q1 ORTHOPEDICS
Oisin J F Keenan, Lauren A Ross, Matthew Magill, Matthew Moran, Chloe E H Scott
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引用次数: 7

Abstract

Purpose: This study aimed to determine whether unrestricted weight-bearing as tolerated (WBAT) following lateral locking plate (LLP) fixation of periprosthetic distal femoral fractures (PDFFs) is associated with increased failure and reoperation, compared with restricted weight-bearing (RWB).

Materials and methods: In a retrospective cohort study of consecutive patients with unilateral PDFFs undergoing LLP fixation, patients prescribed WBAT were compared with those prescribed 6 weeks of RWB. The primary outcome measure was reoperation. Kaplan-Meier and Cox multivariable analyses were performed.

Results: There were 43 patients (mean age 80.9 ± 11.7 years, body mass index 26.8 ± 5.7 kg/m2 and 86.0% female): 28 WBAT and 15 RWB. There were more interprosthetic fractures in the RWB group (p = 0.040). Mean follow-up was 3.8 years (range 1.0-10.4). Eight patients (18.6%) underwent reoperation. Kaplan-Meier analysis demonstrated no difference in 2-year survival between WBAT (80.6%, 95% CI 65.3-95.9) and RWB (83.3%, 95% CI 62.1-100.0; p = 0.54). Cox analysis showed increased reoperation risk with medial comminution (hazard ratio 10.7, 95% CI 1.5-80; p = 0.020) and decreased risk with anatomic reduction (hazard ratio 0.11, 95% CI 0.01-1.0; p = 0.046). Immediate weight-bearing did not significantly affect the risk of reoperation compared with RWB (relative risk 1.03, 95% CI 0.61-1.74; p = 0.91).

Conclusions: LLP fixation failure was associated with medial comminution and non-anatomic reductions, not with postoperative weight-bearing. Medial comminution should be managed with additional fixation. Weight-bearing restrictions additional to this appear unnecessary and should be avoided.

Abstract Image

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股骨远端假体周围骨折外侧锁定钢板固定后立即负重是安全的。
目的:本研究旨在确定与限制性负重(RWB)相比,外侧锁定钢板(LLP)固定股骨远端假体周围骨折(pdff)后无限制耐受负重(WBAT)是否与失败率和再手术率增加有关。材料和方法:在一项对连续单侧pdff患者进行LLP固定的回顾性队列研究中,将使用WBAT的患者与使用6周RWB的患者进行比较。主要观察指标为再手术。Kaplan-Meier和Cox多变量分析。结果:43例患者(平均年龄80.9±11.7岁,体重指数26.8±5.7 kg/m2,女性86.0%):WBAT 28例,RWB 15例。RWB组假体间骨折发生率较高(p = 0.040)。平均随访3.8年(1.0-10.4年)。再次手术8例(18.6%)。Kaplan-Meier分析显示,WBAT (80.6%, 95% CI 65.3-95.9)和RWB (83.3%, 95% CI 62.1-100.0)的2年生存率无差异;p = 0.54)。Cox分析显示,内侧粉碎增加了再手术风险(危险比10.7,95% CI 1.5-80;p = 0.020),解剖复位后风险降低(风险比0.11,95% CI 0.01-1.0;p = 0.046)。与RWB相比,即刻负重对再手术风险无显著影响(相对危险度1.03,95% CI 0.61-1.74;p = 0.91)。结论:LLP固定失败与内侧粉碎和非解剖复位有关,与术后负重无关。内侧粉碎性骨折应加固定处理。额外的负重限制似乎是不必要的,应该避免。
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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CiteScore
3.40
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