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
{"title":"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","authors":"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","doi":"10.1097/BOT.0000000000002680","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To identify technical factors associated with nonunion after operative treatment with lateral locked plating.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Ten Level I trauma centers.</p><p><strong>Patient selection criteria: </strong>Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019.</p><p><strong>Outcome measures and comparisons: </strong>Surgery for nonunion stratified by risk for nonunion.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":"49-55"},"PeriodicalIF":1.6000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated With Lateral Locked Plating: A Risk-Stratified Analysis.\",\"authors\":\"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\",\"doi\":\"10.1097/BOT.0000000000002680\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To identify technical factors associated with nonunion after operative treatment with lateral locked plating.</p><p><strong>Methods: </strong></p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Ten Level I trauma centers.</p><p><strong>Patient selection criteria: </strong>Adult patients with supracondylar distal femur fractures (OTA/AO type 33A or C) treated with lateral locked plating from 2010 through 2019.</p><p><strong>Outcome measures and comparisons: </strong>Surgery for nonunion stratified by risk for nonunion.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"49-55\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Orthopaedic Trauma\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BOT.0000000000002680\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Orthopaedic Trauma","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BOT.0000000000002680","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated With Lateral Locked Plating: A Risk-Stratified Analysis.
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.
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.
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