Timing of radiographic healing for distal femur fractures treated with intramedullary nails.

IF 1.6 3区医学 Q3 ORTHOPEDICS Journal of Orthopaedic Trauma Pub Date : 2024-09-26 DOI:10.1097/BOT.0000000000002915

Dane Brodke, Sai Devana, Adolfo Hernandez, Nathan O'Hara, Cynthia Burke, Jayesh Gupta, Natasha McKibben, Robert O'Toole, John Morellato, Hunter Gillon, Murphy Walters, Colby Barber, Paul Perdue, Graham Dekeyser, Lillia Steffenson, Lucas Marchand, Marshall James Fairres, Loren Black, Erika Roddy, Ashraf El Naga, Matthew Hogue, Trevor Gulbrandsen, Omar Atassi, Thomas Mitchell, Stephen Shymon, Zachary Working, Christopher Lee

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Abstract

Objectives: This study aimed to profile modified Radiographic Union Scale for Tibia (mRUST) scores over time in distal femur fractures treated with intramedullary nails and identify predictors of radiographic union timing and delayed progression.

Methods: Design: Multicenter retrospective cohort study.

Setting: Ten Level I Trauma Centers.

Patient selection criteria: The inclusion criteria were patients with distal femur fractures (OTA/AO 33A and 33C) treated with intramedullary nails, with a minimum follow-up of one year or until radiographic union or reoperation. The exclusion criteria were fractures treated with combination nail-plate constructs, pathologic fractures, and patients under 18 years old.Outcome Measures and Comparisons: The primary outcome was the mRUST score at 3, 6, and 12 months post-operatively. Receiver operating characteristic (ROC) curve analysis identified the optimal 3-month mRUST score predicting reoperation. Multivariable models were used to identify predictors of radiographic union timing and delayed progression.

Results: The study included 155 fractures in 152 patients, with a mean patient age of 51 and a mean follow-up of 17 months. A 3-month mRUST score of ≤8 predicted reoperation with a PPV of 25%, and a NPV of 99%. The timing of radiographic union was associated with tobacco use (1.2 months later; p = 0.04), open fracture (1.4 months later; p = 0.04), and the use of topical antibiotics (2.1 months longer; 95% CI: 0.33 - 3.84; p = 0.02), however topical antibiotics was at high risk of being confounded by injury severity. Delayed progression to fracture healing, wherein the most rapid radiographic healing occurs more than 3 months post-operatively, was predicted by chronic kidney disease (p < 0.01).

Conclusions: A 3-month mRUST score >8 suggests a very high likelihood of avoiding reoperation for nonunion.Tobacco use and open fractures were associated with a longer time to radiographic union. Chronic kidney disease is associated with a delayed radiographic progression, suggesting a need for adjusted expectations and management strategies in these patients.

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

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使用髓内钉治疗股骨远端骨折的影像学愈合时间。

研究目的本研究旨在分析使用髓内钉治疗的股骨远端骨折患者随时间变化的改良胫骨放射学结合量表（mRUST）评分，并确定放射学结合时间和延迟进展的预测因素：方法：设计：多中心回顾性队列研究：患者选择标准：纳入标准：使用髓内钉治疗的股骨远端骨折（OTA/AO 33A和33C）患者，随访至少一年或直至放射学结合或再次手术。排除标准为使用髓内钉-钢板组合结构治疗的骨折、病理性骨折以及未满18岁的患者：主要结果是术后3、6和12个月的mRUST评分。接收者操作特征（ROC）曲线分析确定了预测再次手术的最佳3个月mRUST评分。多变量模型用于确定放射学结合时间和延迟进展的预测因素：研究包括 152 名患者的 155 处骨折，患者平均年龄为 51 岁，平均随访时间为 17 个月。3个月的mRUST评分≤8可预测再次手术，PPV为25%，NPV为99%。放射学结合的时间与吸烟（1.2 个月后；p = 0.04）、开放性骨折（1.4 个月后；p = 0.04）和局部抗生素的使用（延长 2.1 个月；95% CI：0.33 - 3.84；p = 0.02）有关，但局部抗生素的使用很有可能受到损伤严重程度的影响。慢性肾脏病会导致骨折愈合进展延迟，即术后3个月以上才会出现最快速的影像学愈合（p < 0.01）：结论：3 个月的 mRUST 评分大于 8 分表明避免因骨折不愈合而再次手术的可能性非常大。慢性肾病与放射学进展延迟有关，这表明需要对这些患者的预期和管理策略进行调整：预后III级。有关证据级别的完整描述，请参阅 "作者须知"。

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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.