Journal of orthopaedic trauma · 2024
Staged Management for Distal Femur Fractures: Impacts on Reoperation, Stiffness, and Overall Outcomes.
СтатьяНазвание и аннотация: Перевод в очереди
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Yeager Matthew T, Rutz Robert W, Roszman Alex, McGwin Gerald, Darnley James E, Johnson Joseph P, Spitler Clay A
Аннотация
OBJECTIVES: To evaluate the outcomes of staged management with external fixation (ex-fix) before definitive fixation of distal femur fractures.
DESIGN: Retrospective cohort.
SETTING: Single Level I Trauma Center.
PATIENT SELECTION CRITERIA: Adults treated operatively between 2004 and 2019 for distal femur fractures (OTA/AO 33A/33C) were identified using Current Procedural Terminology codes. Excluded cases were those with screw only fixation, acute distal femur replacement, 33B fracture pattern, no radiographs available, or did not have 6-months of follow-up.
OUTCOME MEASURES AND COMPARISONS: Postoperative complication rates including surgical site infection [SSI], reoperation to promote bone healing, final knee arc of motion <90 degrees, heterotopic ossification formation, and reoperation for stiffness were compared between patients treated with ex-fix before definitive fixation and those not requiring ex-fix.
RESULTS: A total of 407 patients were included with a mean follow-up of 27 months [median (IQR) of 12 (7.33) months] (range 6-192 months). Most patients were male (52%) with an average age of 48 (range: 18-92) years. Ex-fix was utilized in 150 (37%) cases and 257 (63%) cases underwent primary definitive fixation. There was no difference in SSI rates ( P = 0.12), final knee arc of motion <90 degrees ( P = 0.51), and reoperation for stiffness ( P = 0.41) between the ex-fix and no ex-fix groups. The 150 patients requiring ex-fix spent an average of 4.2 days (SD 3.3) in the ex-fix before definitive fixation. These patients were further analyzed by comparing the duration of time spent in ex-fix, <4 days (n = 82) and ≥4 days (n = 68). Despite longer time spent in ex-fix before definitive fixation, there was again no significant difference in any of the complication and reoperation rates when comparing the 2 groups, including final knee arc of motion <90 degrees ( P = 0.63), reoperation for stiffness ( P = 1.00), and SSI ( P = 0.79).
CONCLUSION: Ex-fix of distal femur fractures as a means of temporary stabilization before definitive open reduction internal fixation does not increase the risk of complications such as SSI, final knee arc of motion <90 degrees, or reoperations for bone healing or stiffness when compared with single-stage open reduction internal fixation of distal femur fractures.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
DESIGN: Retrospective cohort.
SETTING: Single Level I Trauma Center.
PATIENT SELECTION CRITERIA: Adults treated operatively between 2004 and 2019 for distal femur fractures (OTA/AO 33A/33C) were identified using Current Procedural Terminology codes. Excluded cases were those with screw only fixation, acute distal femur replacement, 33B fracture pattern, no radiographs available, or did not have 6-months of follow-up.
OUTCOME MEASURES AND COMPARISONS: Postoperative complication rates including surgical site infection [SSI], reoperation to promote bone healing, final knee arc of motion <90 degrees, heterotopic ossification formation, and reoperation for stiffness were compared between patients treated with ex-fix before definitive fixation and those not requiring ex-fix.
RESULTS: A total of 407 patients were included with a mean follow-up of 27 months [median (IQR) of 12 (7.33) months] (range 6-192 months). Most patients were male (52%) with an average age of 48 (range: 18-92) years. Ex-fix was utilized in 150 (37%) cases and 257 (63%) cases underwent primary definitive fixation. There was no difference in SSI rates ( P = 0.12), final knee arc of motion <90 degrees ( P = 0.51), and reoperation for stiffness ( P = 0.41) between the ex-fix and no ex-fix groups. The 150 patients requiring ex-fix spent an average of 4.2 days (SD 3.3) in the ex-fix before definitive fixation. These patients were further analyzed by comparing the duration of time spent in ex-fix, <4 days (n = 82) and ≥4 days (n = 68). Despite longer time spent in ex-fix before definitive fixation, there was again no significant difference in any of the complication and reoperation rates when comparing the 2 groups, including final knee arc of motion <90 degrees ( P = 0.63), reoperation for stiffness ( P = 1.00), and SSI ( P = 0.79).
CONCLUSION: Ex-fix of distal femur fractures as a means of temporary stabilization before definitive open reduction internal fixation does not increase the risk of complications such as SSI, final knee arc of motion <90 degrees, or reoperations for bone healing or stiffness when compared with single-stage open reduction internal fixation of distal femur fractures.
LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.