How does intraoperative fracture malalignment affect postoperative function and bone healing following distal femoral fracture?

Abstract

Aims Postoperative malalignment of the femur is one of the main complications in distal femur fractures. Few papers have investigated the impact of intraoperative malalignment on postoperative function and bone healing outcomes. The aim of this study was to investigate how intraoperative fracture malalignment affects postoperative bone healing and functional outcomes. Methods In total, 140 patients were retrospectively identified from data obtained from a database of hospitals participating in a trauma research group. We divided them into two groups according to coronal plane malalignment of more than 5°: 108 had satisfactory fracture alignment (< 5°, group S), and 32 had unsatisfactory alignment (> 5°, group U). Patient characteristics and injury-related factors were recorded. We compared the rates of nonunion, implant failure, and reoperation as healing outcomes and Knee Society Score (KSS) at three, six, and 12 months as functional outcomes. We also performed a sub-analysis to assess the effect of fracture malalignment by plates and nails on postoperative outcomes. Results The rates of nonunion and reoperation in group U were worse than those in group S (25.0% vs 14.3%; 15.6% vs 5.6%), but the differences were not significant (p = 0.180 and p = 0.126, respectively). Mean KSS in group U at all follow-up periods was significantly worse that in group S (75.7 (SD 18.8) vs 86.0 (SD 8.7); p < 0.001; 78.9 (SD 17.2) vs 89.1 (SD 9.8); p < 0.001; 85.0 (SD 11.9) vs 91.1 (SD 7.2); p = 0.002, respectively). In the sub-analysis of plates, mean KSS was significantly worse in group U at three and six months. In the sub-analysis of nails, the rate of reoperation was significantly higher in group U (28.6% vs 5.8%; p = 0.025), and mean KSS at six and 12 months was significantly worse in Group U. Conclusion To obtain good postoperative functional results, intraoperative alignment of the coronal plane should be accurately restored to less than 5°. Cite this article: Bone Jt Open 2022;3(2):165–172.

The double-plate fixation technique prevents varus collapse in AO type C3 supra-intercondylar fracture of the distal femur

“…However, varus deformity still occurs, and its incidence is reported to be 8% in AO type C3 fractures[ 23 ].Clinically, any degree of varus malunion resulted in post-traumatic osteoarthritis of the knee joint during the long-term follow-up [ 24 , 25 ]. A malalignment of < 5° in the coronal plane resulted in better functional outcomes [ 26 ].…”

Using a Traction Table for Fracture Reduction during Minimally Invasive Plate Osteosynthesis (MIPO) of Distal Femoral Fractures Provides Anatomical Alignment

“…Rotational malalignment of more than 15° was seen in only one patient, which is less frequent than previously published results [ 8 , 9 , 10 ]. We believe these results are clinically relevant, as improved postoperative alignment correlates with improved functional outcomes and decreased risk of non-union [ 13 , 14 ]. Improved rotational alignment also lowers the risk of articular cartilage shearing, negatively affecting knee function and promoting osteoarthritis [ 15 , 16 , 17 ].…”

“…However, the lack of clear landmarks in the femur makes per-operative validation of reduction difficult, particularly of rotation, regardless of whether a nail or plate is used, and mal-reduction is not uncommon [ 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Postoperative malalignment increases the risk of non-union [ 13 , 14 ]. Rotational malalignment has also been shown to have a negative impact on knee function, resulting in articular cartilage shearing, which can, in turn, develop into painful osteoarthritis [ 15 , 16 , 17 ].…”

Surgical approaches to periprosthetic femoral fractures for plate fixation or revision arthroplasty

“…Reduction in the coronal plane is especially important for union. 12 The patient is positioned supine with the knee flexed over a triangle to de-tension gastrocnemius (Supplementary Figure d). No tourniquet is used.…”