Tratamiento de fracturas supracondíleas de fémur mediante técnicas mínimamente invasivas vs. exposición del foco de fractura: un estudio de cohortes retrospectivas

Abstract

Introduction

Fractures of the distal femoral third are an important cause of morbidity and mortality, and their treatment is currently controversial.

Objectives

To compare the results between minimally invasive techniques versus exposure of the fracture site. Secondly, to evaluate the relationship between demographic factors, mechanism of injury and surgical delay with patient prognosis.

Method

Retrospective cohort study carried out between 2015 and 2021 in a tertiary hospital. Data collection was performed by reviewing medical histories, measuring demographic and hospital parameters and definitive treatment strategy. One year of follow-up was completed in all patients, assessing the occurrence of surgical complications and mortality. A stratified analysis of the variables of interest was performed among patients over 65 years of age.

Results

128 fractures were recorded, with definitive osteosynthesis being performed in 117. Patients who underwent minimally invasive techniques required a shorter hospital stay (9 [7-12] vs. 12 [8.75-16] days) (p = 0.007), with no differences in mortality or complications during follow-up. In those over 65 years of age, opening the fracture site was associated with an increased risk of infection compared to minimally invasive techniques (33.3% vs. 2%) (p = 0.507). All the deceased were patients over 65 years of age (33.7% at one year). Surgical delay longer than 48 hours increased mortality by 10% among those older than 65 years (p = 0.3). High-energy trauma had a higher proportion of pseudarthrosis (27.6% vs. 6.1%) (p = 0.011).

Conclusions

Minimally invasive techniques decreased hospital stay but not complications or long-term mortality.

Level of evidence: IIb.