Robert K Wagner, Derek van Duuren, Jacob S Borgida, Austin T Gregg, Adam N Musick, Wei Shao Tung, Thomas J Policicchio, Maaz Muhammad, Carla H Lehle, Frank W Bloemers, Arun Aneja, Stein J Janssen, Thuan V Ly
{"title":"股骨远端假体周围骨折外侧锁定钢板后骨不愈合的危险因素。","authors":"Robert K Wagner, Derek van Duuren, Jacob S Borgida, Austin T Gregg, Adam N Musick, Wei Shao Tung, Thomas J Policicchio, Maaz Muhammad, Carla H Lehle, Frank W Bloemers, Arun Aneja, Stein J Janssen, Thuan V Ly","doi":"10.1097/BOT.0000000000003001","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To determine the rate of and risk factors for reoperation to promote fracture union of periprosthetic distal femur fractures treated with lateral locked plating.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two Level 1 Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Adult patients undergoing operative treatment for a periprosthetic distal femur fracture (OTA/AO 33A or 33C) between 2006 and 2023 with a minimum follow-up of 3 months.</p><p><strong>Outcome measures and comparisons: </strong>Reoperation to promote fracture union compared across patient, fracture, and treatment characteristics.</p><p><strong>Results: </strong>218 patients (mean age 72 years [range: 52-84], 77% female) were included. There were 133 (61%) Su type 2 fractures, 10 (4.6%) open injuries, and 118 (54%) fractures with multifragmentary comminution of the metaphysis. Twenty (9.2%) patients required reoperation to promote fracture union, including 15 (6.9%) patients who presented with nonunion with implant failure. In multivariable logistic regression analysis, BMI (5-point increase; OR: 1.37 [95% CI: 1.00-1.86], p = 0.047), multifragmentary metaphyseal comminution (OR: 5.17 [95% CI: 1.47-18.3], p = 0.011), and varus malalignment (OR: 5.88 [95% CI: 1.29-26.8], p = 0.023) were associated with increased odds of reoperation for nonunion; whereas the use of titanium plates was protective (OR: 0.21 [95% CI: 0.07-0.63], p = 0.005).</p><p><strong>Conclusions: </strong>In this study of 218 patients undergoing lateral locked plating for a periprosthetic distal femur fracture, 9 out of 10 patients did not undergo reoperation to promote fracture union. Factors associated with reoperation included increased BMI, the presence of multifragmentary metaphyseal comminution, and varus malalignment with a lateral distal femoral angle of ≥84 degrees. The use of titanium plates was associated with decreased odds of reoperation although this finding should be interpreted in the context of varying plate designs and configurations. These results may help delineate indications for the selection of specific fixation constructs when treating periprosthetic distal femur fractures.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factors for Nonunion After Lateral Locked Plating of Periprosthetic Distal Femur Fractures.\",\"authors\":\"Robert K Wagner, Derek van Duuren, Jacob S Borgida, Austin T Gregg, Adam N Musick, Wei Shao Tung, Thomas J Policicchio, Maaz Muhammad, Carla H Lehle, Frank W Bloemers, Arun Aneja, Stein J Janssen, Thuan V Ly\",\"doi\":\"10.1097/BOT.0000000000003001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To determine the rate of and risk factors for reoperation to promote fracture union of periprosthetic distal femur fractures treated with lateral locked plating.</p><p><strong>Methods: </strong>Design: Retrospective cohort study.</p><p><strong>Setting: </strong>Two Level 1 Trauma Centers.</p><p><strong>Patient selection criteria: </strong>Adult patients undergoing operative treatment for a periprosthetic distal femur fracture (OTA/AO 33A or 33C) between 2006 and 2023 with a minimum follow-up of 3 months.</p><p><strong>Outcome measures and comparisons: </strong>Reoperation to promote fracture union compared across patient, fracture, and treatment characteristics.</p><p><strong>Results: </strong>218 patients (mean age 72 years [range: 52-84], 77% female) were included. There were 133 (61%) Su type 2 fractures, 10 (4.6%) open injuries, and 118 (54%) fractures with multifragmentary comminution of the metaphysis. Twenty (9.2%) patients required reoperation to promote fracture union, including 15 (6.9%) patients who presented with nonunion with implant failure. In multivariable logistic regression analysis, BMI (5-point increase; OR: 1.37 [95% CI: 1.00-1.86], p = 0.047), multifragmentary metaphyseal comminution (OR: 5.17 [95% CI: 1.47-18.3], p = 0.011), and varus malalignment (OR: 5.88 [95% CI: 1.29-26.8], p = 0.023) were associated with increased odds of reoperation for nonunion; whereas the use of titanium plates was protective (OR: 0.21 [95% CI: 0.07-0.63], p = 0.005).</p><p><strong>Conclusions: </strong>In this study of 218 patients undergoing lateral locked plating for a periprosthetic distal femur fracture, 9 out of 10 patients did not undergo reoperation to promote fracture union. Factors associated with reoperation included increased BMI, the presence of multifragmentary metaphyseal comminution, and varus malalignment with a lateral distal femoral angle of ≥84 degrees. The use of titanium plates was associated with decreased odds of reoperation although this finding should be interpreted in the context of varying plate designs and configurations. These results may help delineate indications for the selection of specific fixation constructs when treating periprosthetic distal femur fractures.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-04-23\",\"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.0000000000003001\",\"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.0000000000003001","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：探讨外侧锁定钢板治疗股骨远端假体周围骨折的再手术率及危险因素。方法：设计：回顾性队列研究。环境：两个一级创伤中心。患者选择标准：2006年至2023年间因假体周围股骨远端骨折（OTA/ ao33a或33C）接受手术治疗的成年患者，至少随访3个月。结果测量和比较：再手术促进骨折愈合的患者、骨折和治疗特点的比较。结果：纳入218例患者，平均年龄72岁[范围：52-84]，其中77%为女性。Su 2型骨折133例（61%），开放性骨折10例（4.6%），干骺端多碎片粉碎骨折118例（54%）。20例（9.2%）患者需要再次手术以促进骨折愈合，其中15例（6.9%）患者出现骨不连并植入物失败。在多变量logistic回归分析中，BMI(增加5点；OR: 1.37 [95% CI: 1.00-1.86], p = 0.047)、多碎片性干骺端粉碎（OR: 5.17 [95% CI: 1.47-18.3], p = 0.011）和内翻畸形（OR: 5.88 [95% CI: 1.29-26.8], p = 0.023）与再手术不愈合的几率增加有关；而钛板的使用具有保护作用（OR: 0.21 [95% CI: 0.07-0.63], p = 0.005）。结论：在本研究中，218例患者接受外侧锁定钢板治疗假体周围股骨远端骨折，10例患者中有9例没有再手术促进骨折愈合。与再手术相关的因素包括BMI升高、多碎片性干骺端粉碎、股骨远端外侧角≥84度的内翻错位。钛板的使用与再次手术的几率降低有关，尽管这一发现应该在不同板设计和配置的背景下进行解释。这些结果可能有助于描述治疗股骨远端假体周围骨折时选择特定固定结构的适应症。
Risk Factors for Nonunion After Lateral Locked Plating of Periprosthetic Distal Femur Fractures.
Objectives: To determine the rate of and risk factors for reoperation to promote fracture union of periprosthetic distal femur fractures treated with lateral locked plating.
Methods: Design: Retrospective cohort study.
Setting: Two Level 1 Trauma Centers.
Patient selection criteria: Adult patients undergoing operative treatment for a periprosthetic distal femur fracture (OTA/AO 33A or 33C) between 2006 and 2023 with a minimum follow-up of 3 months.
Outcome measures and comparisons: Reoperation to promote fracture union compared across patient, fracture, and treatment characteristics.
Results: 218 patients (mean age 72 years [range: 52-84], 77% female) were included. There were 133 (61%) Su type 2 fractures, 10 (4.6%) open injuries, and 118 (54%) fractures with multifragmentary comminution of the metaphysis. Twenty (9.2%) patients required reoperation to promote fracture union, including 15 (6.9%) patients who presented with nonunion with implant failure. In multivariable logistic regression analysis, BMI (5-point increase; OR: 1.37 [95% CI: 1.00-1.86], p = 0.047), multifragmentary metaphyseal comminution (OR: 5.17 [95% CI: 1.47-18.3], p = 0.011), and varus malalignment (OR: 5.88 [95% CI: 1.29-26.8], p = 0.023) were associated with increased odds of reoperation for nonunion; whereas the use of titanium plates was protective (OR: 0.21 [95% CI: 0.07-0.63], p = 0.005).
Conclusions: In this study of 218 patients undergoing lateral locked plating for a periprosthetic distal femur fracture, 9 out of 10 patients did not undergo reoperation to promote fracture union. Factors associated with reoperation included increased BMI, the presence of multifragmentary metaphyseal comminution, and varus malalignment with a lateral distal femoral angle of ≥84 degrees. The use of titanium plates was associated with decreased odds of reoperation although this finding should be interpreted in the context of varying plate designs and configurations. These results may help delineate indications for the selection of specific fixation constructs when treating periprosthetic distal femur fractures.
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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