Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study.

IF 1.6 3区医学 Q3 ORTHOPEDICS Journal of Orthopaedic Trauma Pub Date : 2024-02-01 DOI:10.1097/BOT.0000000000002730

Noelle L Van Rysselberghe, Ryan Seltzer, Taylor A Lawson, Justin Kuether, Parker White, Phillip Grisdela, Hayley Daniell, Arya Amirhekmat, Nelson Merchan, Thomas Seaver, Aneesh Samineni, Augustine Saiz, Daniel Ngo, Clark Dorman, Eden Epner, Reese Svetgoff, Megan Terle, Mark Lee, Sean Campbell, Gregory Dikos, Stephen Warner, Timothy Achor, Michael J Weaver, Paul Tornetta, John Scolaro, John J Wixted, Timothy Weber, Michael J Bellino, L Henry Goodnough, Michael J Gardner, Julius A Bishop

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Abstract

Objectives: To compare clinical and radiographic outcomes after retrograde intramedullary nailing (rIMN) versus locked plating (LP) of "extreme distal" periprosthetic femur fractures, defined as those that contact or extend distal to the anterior flange.

Methods:

Design: Retrospective review.

Setting: Eight academic level I trauma centers.

Patient selection criteria: Adult patients with periprosthetic distal femur fractures at or distal to the anterior flange (OTA/AO 33B-C[VB1]) treated with rIMN or LP.

Outcome measures and comparisons: The primary outcome was reoperation to promote healing or to treat infection (reoperation for elective removal of symptomatic hardware was excluded from this analysis). Secondary outcomes included nonunion, delayed union, fixation failure, infection, overall reoperation rate, distal femoral alignment, and ambulatory status at final follow-up. Outcomes were compared between patients treated with rIMN or LP.

Results: Seventy-one patients treated with rIMN and 224 patients treated with LP were included. The rIMN group had fewer points of fixation in the distal segment (rIMN: 3.5 ± 1.1 vs. LP: 6.0 ± 1.1, P < 0.001) and more patients who were allowed to weight-bear as tolerated immediately postoperatively (rIMN: 45%; LP: 9%, P < 0.01). Reoperation to promote union and/or treat infection was 8% in the rIMN group and 16% in the LP group ( P = 0.122). There were no significant differences in nonunion ( P > 0.999), delayed union ( P = 0.079), fixation failure ( P > 0.999), infection ( P = 0.084), or overall reoperation rate ( P > 0.999). Significantly more patients in the rIMN group were ambulatory without assistive devices at final follow-up (rIMN: 35%, LP: 18%, P = 0.008).

Conclusions: rIMN of extreme distal periprosthetic femur fractures has similar complication rates compared with LP, with a possible advantage of earlier return to weight-bearing. Surgeons can consider this treatment strategy in all fractures with stable implants and amenable prosthesis geometry, even extreme distal fractures.

Level of evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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逆行髓内钉与锁定钢板治疗股骨远端假体周围骨折:一项多中心回顾性队列研究。

目的:比较逆行髓内钉与锁定钢板治疗“极远端”股骨假体周围骨折的临床和影像学结果，“极远端”股骨假体周围骨折定义为接触或延伸到前法兰远端骨折。环境:8个一级创伤中心。患者选择标准:成年患者假体周围股骨远端骨折前缘或远端(OTA/AO 33B-C[VB1])，经rIMNs或LPs治疗。结果测量和比较:主要结果是再次手术以促进愈合或治疗感染(择期取出有症状的硬体的再次手术排除在本分析之外)。次要结果包括不愈合、延迟愈合、固定失败、感染、总再手术率、股骨远端对准和最终随访时的活动状况。相比之下，使用rIMNs或LPs治疗的患者。结果:纳入71例rIMNs组和224例LPs组。rIMN组远端固定点较少(rIMN: 3.5 +/- 1.1 vs LP: 6.0 +/- 1.1, p0.999)，愈合延迟(p=0.079)，固定失败(p>0.999)，感染(p=0.084)，总再手术率(p>0.999)。在最后随访时，rIMN组中更多的患者在没有辅助装置的情况下走动(rIMN: 35%， LP: 18%， p=0.008)。结论:与锁定钢板相比，逆行髓内钉治疗股骨极远端假体周围骨折的并发症发生率相似，可能具有更早恢复负重的优势。外科医生可以在所有具有稳定植入物和可调节假体几何形状的骨折中考虑这种治疗策略，甚至是极端远端骨折。证据等级:治疗性III级。有关证据水平的完整描述，请参见作者说明。

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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.