RESUMEN
BACKGROUND: Distal femur fractures occur with an incidence of 4.5/100,000 and show a prevalence of 0.4%. Causes include low-impact trauma in older patients and high-impact trauma in younger patients without pre-existing medical conditions. The aim of this study was to perform a comprehensive evaluation of trauma mechanisms, trauma-promoting factors, comorbidities, medication history and type of surgical care to provide an overview of the causes of injury and the most appropriate therapeutic approach. METHODS: In this multicenter cohort study a retrospective analysis of 229 patients who sustained a distal femur fracture between January 2011 and December 2020 was performed. Individual fracture patterns, fracture predisposing factors, concomitant disease profiles, medication history, treatment strategy and associated complications were analyzed. RESULTS: 229 patients were included in the retrospective analysis. A total of 113-type 33 A, 50-type 33 B and 66-type 33 C fractures were diagnosed, of whom 92% received a lateral locking plate osteosynthesis. There was a complication in 14.4% of all cases, of which 6.1% were attributable to infection. Significant risk factors for developing a complication were an increased BMI (29.9 ± 8.5 kg/m2; p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AOC fractures (p < 0,016), specifically C2 fractures (p < 0,008). CONCLUSION: In this multicenter retrospective cohort study, lateral locking plate osteosynthesis was the method of choice and was selected in over 90% of cases, regardless of the fracture classification and risk factors. A complication rate of 14.4% emphasizes the necessary analysis of patient- and care-specific risk factors and a resulting adjustment of the therapy strategy. An increased BMI (29.9 ± 8.5 kg/m2; p = 0.04), fracture displacement of over half a shaft width (p < 0.001) and AOC fractures (p < 0,016), specifically C2 fractures (p < 0,008) increase the risk of developing a complication and should prompt an early switch to a treatment strategy that provides more stability.
Asunto(s)
Fracturas Femorales Distales , Fracturas del Fémur , Fracturas Óseas , Humanos , Anciano , Estudios Retrospectivos , Suiza , Estudios de Cohortes , Nivel de Atención , Fracturas Óseas/cirugía , Fémur , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Placas Óseas , Fracturas del Fémur/epidemiología , Fracturas del Fémur/cirugía , Fracturas del Fémur/etiología , Resultado del TratamientoRESUMEN
INTRODUCTION: The objective of this investigation was to compare different techniques to improve visualization and reduction in tibial plateau fractures involving the central lateral segments. METHODS: Matched pairs of pre-fractured cadaveric tibial plateau fractures that include the central lateral segments were treated by either an anterolateral approach (supine) or PL approach (prone). Reduction was stepwise extended by additional fracturoscopy (FS), nanoscopy (NS) and lastly by epicondyle osteotomy (ECO). Reduction was analyzed by 3D scan and visualization of the lateral plateau was quantified. RESULTS: Ten specimens (3 pairs 41B3.1, 2 pairs 41C3.3) were analyzed. Fracture steps involving the antero-latero-central (ALC) segment were insufficiently reduced after fluoroscopy using both approaches (AL 2.2 ± 1.2 mm vs PL 2.2 ± 1.0 mm, p 0.95). Additional NS and ECO achieved optimized fracture reduction in the ALC segment (NS AL 1.6 ± 1.3 mm vs PL 0.8 ± 0.9 mm, p 0.32). NS provided visualization of the entire lateral plateau (PL 102.9% ± 7.4, AL 108.8 ± 19.2%), while fracturoscopy only allowed visualization of the ALL segment and partially of PLL and ALC segments (PL 22.0 ± 23.4%, AL 29.7 ± 18.3%). CONCLUSION: Optimized reduction of tibial head fractures with involvement of latero-central segments requires additional video-assisted reduction or extended approaches. Nanoscopy helps visualizing of the entire lateral plateau, when compared to fracturoscopy and may become a valuable reduction aid.
Asunto(s)
Fracturas de la Tibia , Fracturas de la Meseta Tibial , Humanos , Fijación Interna de Fracturas/métodos , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Tibia/diagnóstico por imagen , Tibia/cirugía , Cadáver , Resultado del TratamientoRESUMEN
PURPOSE: To gain principal insight into fixation techniques of a posteromedial split fragment in bicondylar tibial plateau fractures. METHODS: A computer simulation was performed, applying the finite-element method (FEM) to compare four methods of fixation of the posteromedial split fragment: lateral plate (model 1), lateral plate and kickstand screw (model 2), lateral plate and two antero-posterior lag screws (model 3), and lateral and posteromedial plate (model 4). The displacement of the fragment and material stresses in implants and bone under 2500 N axial load were analyzed. RESULTS: Maximal displacement of the posteromedial split fragment of 2.8 mm was found with a sole lateral plate. An added kickstand screw decreased the displacement to 1.46 mm. Added lag screws improved stability by a factor 4, with a maximal displacement of 0.76 mm. The double-plate configuration revealed 0.27 mm, a decrease of the displacement by a factor 10 compared to model 1. An additional analysis of posteromedial fragment displacements with osteoporotic bone, simulated by dividing the elastic modulus of the bone by a factor 2, turned out to be of relevant impact. For model 1, the calculations did not converge. The influence of bone quality was found to be 70% in model 2, 60% in model 3, and 40% in model 4. CONCLUSIONS: The results indicate that the additional fixation of a posteromedial split fracture by plate osteosynthesis might be advantageous in bicondylar tibial plateau fractures treated with lateral plating. This might be even more important in patients with low bone quality.