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

被引：1

作者：

Van Rysselberghe, Noelle L. ^{[1
,2
]}

Seltzer, Ryan ^{[1
]}

Lawson, Taylor A. ^{[1
]}

Kuether, Justin ^{[3
]}

White, Parker ^{[3
]}

Grisdela, Phillip ^{[4
]}

Daniell, Hayley ^{[4
]}

Amirhekmat, Arya ^{[5
]}

Merchan, Nelson ^{[6
,7
]}

Seaver, Thomas ^{[8
]}

Samineni, Aneesh ^{[8
]}

Saiz, Augustine ^{[9
]}

Ngo, Daniel ^{[9
]}

Dorman, Clark ^{[9
]}

Epner, Eden ^{[9
]}

Svetgoff, Reese ^{[9
]}

Terle, Megan ^{[10
]}

Lee, Mark ^{[10
]}

Campbell, Sean ^{[10
]}

Dikos, Gregory ^{[3
]}

Warner, Stephen ^{[9
]}

Achor, Timothy ^{[9
]}

Weaver, Michael J. ^{[4
]}

Tornetta, Paul ^{[8
]}

Scolaro, John ^{[5
]}

Wixted, John J. ^{[6
,7
]}

Weber, Timothy ^{[3
]}

Bellino, Michael J. ^{[1
]}

Goodnough, L. Henry ^{[1
]}

Gardner, Michael J. ^{[1
]}

Bishop, Julius A. ^{[1
]}

机构：

[1] Stanford Univ, Sch Med, Dept Orthopaed Surg, Stanford, CA USA

[2] Harborview Med Ctr, Dept Orthopaed & Sports Med, Seattle, WA 98104 USA

[3] St Vincent Trauma Ctr, OrthoIndy Trauma, Indianapolis, IN USA

[4] Harvard Med Sch, Brigham & Womens Hosp, Dept Orthopaed Surg, Boston, MA USA

[5] Univ Calif Irvine, Sch Med, Dept Orthopaed Surg, Orange, CA USA

[6] Harvard Med Sch, Carl J Shapiro Dept Orthopaed Surg, Boston, MA USA

[7] Harvard Med Sch, Ctr Adv Orthopaed Studies, Beth Israel Deaconess Med Ctr, Boston, MA USA

[8] Boston Univ, Med Ctr, Dept Orthopaed Surg, Boston, MA USA

[9] Univ Texas Hlth, McGovern Med Sch, Dept Orthopaed Surg, Houston, TX USA

[10] Univ Calif Davis, Sch Med, Dept Orthopaed Surg, Sacramento, CA USA

来源：

JOURNAL OF ORTHOPAEDIC TRAUMA | 2024年 / 38卷 / 02期

关键词：

retrograde intramedullary nailing; extreme nailing; periprosthetic; distal femur fracture; fragility fractures; ANTERIOR HUMERAL LINE; LATERAL CAPITELLOHUMERAL ANGLE; SUPRACONDYLAR FRACTURES; RADIOCAPITELLAR LINE; CARRYING ANGLE; BAUMANN ANGLE; ELBOW; VARIABILITY; RADIOGRAPHS; CHILDREN;

D O I：

10.1097/BOT.0000000000002730

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

摘要：

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. 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.

引用

页码：57 / 64

页数：8

共 36 条

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