Maria Kammire, Aseel Dib, Madeline Rieker, Ryan Serbin, Charles Arendale, Ziqing Yu, Rachel B Seymour, Suman Medda
{"title":"单钉治疗股骨远端骨折的临床效果与单钉钢板治疗相比，围手术期发病率更低。","authors":"Maria Kammire, Aseel Dib, Madeline Rieker, Ryan Serbin, Charles Arendale, Ziqing Yu, Rachel B Seymour, Suman Medda","doi":"10.1097/BOT.0000000000003064","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To compare outcomes and complications of retrograde intramedullary nailing (rIMN), plating, and combined rIMN+plate constructs for native distal femur fractures.</p><p><strong>Methods design: </strong>Retrospective review of operative distal femur fractures, 2018-2022.</p><p><strong>Setting: </strong>Urban level one trauma center.</p><p><strong>Patient selection criteria: </strong>Included were patients >18 years-old with AO/OTA 33A or 33C distal femur fractures and >=6 months follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, fracture type, operative time, estimated blood loss (EBL), changes in radiographic alignment, union rates (mRUST ≥10), re-operations, complications, and return to weightbearing. were collected and compared between the three fixation constructs.</p><p><strong>Results: </strong>137 patients were included (71 rIMN, 27 plate, 39 rIMN+plate). Median age was older for rIMN+plate compared to rIMN (61 vs 54 years, P =0.015) and similar between rIMN+plate and plate groups (61 years for both, P = 0.68) . There were no other differences in demographics among groups (P>0.05). The rIMN+plate group had longer operative time (256 min) and higher EBL (250cc) compared to rIMN alone (150 min, P = 0.0006 and 200cc, P = 0.023) and similar operative time and EBL compared to plate alone (168 min, P = 0.071 and 250cc, P = 0.73) There were no differences in final coronal or sagittal alignment (P=0.78, P=0.87 respectively) or reoperation rates (P=0.74) among groups. The rIMN+plate group showed a higher rate of radiographic union (66.7%) compared to the rIMN (42.3%) and plate (44.4%) groups (P=0.042) . When controlling for patient age, time to weight bearing was similar among the groups (P =0.79).</p><p><strong>Conclusions: </strong>While the rIMN+plate combination led to higher rates of union, it did not decrease time to weightbearing or re-operation rates compared to rIMN alone, and was associated with longer operative time and greater blood loss.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16644,"journal":{"name":"Journal of Orthopaedic Trauma","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nail Alone Results in Similar Clinical Outcomes with Less Perioperative Morbidity Compared to Nail Plate Combination In Treatment of Native Distal Femur Fractures.\",\"authors\":\"Maria Kammire, Aseel Dib, Madeline Rieker, Ryan Serbin, Charles Arendale, Ziqing Yu, Rachel B Seymour, Suman Medda\",\"doi\":\"10.1097/BOT.0000000000003064\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To compare outcomes and complications of retrograde intramedullary nailing (rIMN), plating, and combined rIMN+plate constructs for native distal femur fractures.</p><p><strong>Methods design: </strong>Retrospective review of operative distal femur fractures, 2018-2022.</p><p><strong>Setting: </strong>Urban level one trauma center.</p><p><strong>Patient selection criteria: </strong>Included were patients >18 years-old with AO/OTA 33A or 33C distal femur fractures and >=6 months follow-up.</p><p><strong>Outcome measures and comparisons: </strong>Demographics, fracture type, operative time, estimated blood loss (EBL), changes in radiographic alignment, union rates (mRUST ≥10), re-operations, complications, and return to weightbearing. were collected and compared between the three fixation constructs.</p><p><strong>Results: </strong>137 patients were included (71 rIMN, 27 plate, 39 rIMN+plate). Median age was older for rIMN+plate compared to rIMN (61 vs 54 years, P =0.015) and similar between rIMN+plate and plate groups (61 years for both, P = 0.68) . There were no other differences in demographics among groups (P>0.05). The rIMN+plate group had longer operative time (256 min) and higher EBL (250cc) compared to rIMN alone (150 min, P = 0.0006 and 200cc, P = 0.023) and similar operative time and EBL compared to plate alone (168 min, P = 0.071 and 250cc, P = 0.73) There were no differences in final coronal or sagittal alignment (P=0.78, P=0.87 respectively) or reoperation rates (P=0.74) among groups. The rIMN+plate group showed a higher rate of radiographic union (66.7%) compared to the rIMN (42.3%) and plate (44.4%) groups (P=0.042) . When controlling for patient age, time to weight bearing was similar among the groups (P =0.79).</p><p><strong>Conclusions: </strong>While the rIMN+plate combination led to higher rates of union, it did not decrease time to weightbearing or re-operation rates compared to rIMN alone, and was associated with longer operative time and greater blood loss.</p><p><strong>Level of evidence: </strong>Level III.</p>\",\"PeriodicalId\":16644,\"journal\":{\"name\":\"Journal of Orthopaedic Trauma\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-09-04\",\"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.0000000000003064\",\"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.0000000000003064","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Nail Alone Results in Similar Clinical Outcomes with Less Perioperative Morbidity Compared to Nail Plate Combination In Treatment of Native Distal Femur Fractures.
Objectives: To compare outcomes and complications of retrograde intramedullary nailing (rIMN), plating, and combined rIMN+plate constructs for native distal femur fractures.
Methods design: Retrospective review of operative distal femur fractures, 2018-2022.
Setting: Urban level one trauma center.
Patient selection criteria: Included were patients >18 years-old with AO/OTA 33A or 33C distal femur fractures and >=6 months follow-up.
Outcome measures and comparisons: Demographics, fracture type, operative time, estimated blood loss (EBL), changes in radiographic alignment, union rates (mRUST ≥10), re-operations, complications, and return to weightbearing. were collected and compared between the three fixation constructs.
Results: 137 patients were included (71 rIMN, 27 plate, 39 rIMN+plate). Median age was older for rIMN+plate compared to rIMN (61 vs 54 years, P =0.015) and similar between rIMN+plate and plate groups (61 years for both, P = 0.68) . There were no other differences in demographics among groups (P>0.05). The rIMN+plate group had longer operative time (256 min) and higher EBL (250cc) compared to rIMN alone (150 min, P = 0.0006 and 200cc, P = 0.023) and similar operative time and EBL compared to plate alone (168 min, P = 0.071 and 250cc, P = 0.73) There were no differences in final coronal or sagittal alignment (P=0.78, P=0.87 respectively) or reoperation rates (P=0.74) among groups. The rIMN+plate group showed a higher rate of radiographic union (66.7%) compared to the rIMN (42.3%) and plate (44.4%) groups (P=0.042) . When controlling for patient age, time to weight bearing was similar among the groups (P =0.79).
Conclusions: While the rIMN+plate combination led to higher rates of union, it did not decrease time to weightbearing or re-operation rates compared to rIMN alone, and was associated with longer operative time and greater blood loss.
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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