Risk Factors for Reoperation to Promote Union in 1111 Distal Femur Fractures

Abstract

Intervention: Surgical fixation of distal femur fracture. Fixation constructs were classified as lateral plate, dual plate, nail, or nail plate combination. Main Outcome Measurements:The outcome of interest was unplanned reoperation to promote union.Results: There was an 11% (121/1111) rate of unplanned reoperation to promote union. In the multivariate analysis, predictive factors included body mass index [odds ratio (OR) = 1.18; 95% confidence interval (CI), 1.06-1.32; P , 0.01], intra-articular fracture (OR = 1.57; 95% CI, 1.01-2.45; P = 0.04), type III open injury (OR = 2.29; 95% CI, 1.41-3.72; P , 0.01), the presence of medial comminution (OR = 1.85; 95% CI, 1.14-3.06; P = 0.01), and medial translation on postoperative radiographs (OR = 1.23 per one 10th of condylar width; 95% CI, 1.01-1.48; P = 0.03). Construct type was not significantly predictive.Conclusions: Eleven percent of distal femur fractures underwent unplanned reoperation to promote union. Body mass index, intraarticular fracture, type III open injury, medial comminution, and medial translation on postoperative radiographs were predictive factors. Construct type was not associated with unplanned reoperation; however, this conclusion was limited by small numbers in the dual plate and nail plate groups.

Risk factors for failure in 228 periprosthetic distal femur fractures: a multicenter study.

“…Titanium plates have previously been suggested to favor the formation of callus by increasing micromotion in the fixation construct given the lower modulus of elasticity of titanium compared with stainless steel plates. [18][19][20] Titanium versus stainless steel was not predictive of reoperation to promote union in this cohort. Quality of fracture reduction was also assessed.…”

“…This result is consistent with previously reported studies in both periprosthetic and native distal femur fractures. 16–18 We did not find any significant association between need for revision surgery to promote union and patient age, sex, diabetes, open fracture type, or immediate weight-bearing as tolerated postoperatively, although this is in some part due to limited patient numbers.…”

“…Furthermore, how the joint replacement was initially positioned, in relative to varus or valgus, would have numerous implications on postreduction stability. Interestingly, Lee et al 18 found medial translation of the articular block to be predictive of the need for reoperation to promote union in 1111 distal femur fractures treated with a variety of fixation constructs. Although this study had a large sample size, the CI for the reported OR was close to overlapping (OR 1.23, CI 1.01-1.38, P = 0.03).…”

Technical Factors Contributing to Nonunion in Supracondylar Distal Femur Fractures Treated with Lateral Locked Plating: A Risk-Stratified Analysis

“…The avoidance of inducing the so-called "golf club deformity" is often advised. 19,20 This study, together with the larger study that includes multiple fixation construct types, 21 is the first that quantifies such translation with an associated nonunion risk.…”

Trauma

“…To address this, a multicentre retrospective cohort study was conducted across ten level I trauma centres in the USA to assess modifiable and non-modifiable risk factors for unplanned reoperation. 7 This large-scale, retrospective cohort study involved ten level I trauma centres across the USA. The cohort consisted of 1,111 patients with OTA/AO 33A or C distal femur fractures who underwent surgical fixation.…”