Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma

Suh, Dongwhan; Ji, Jong‐Hun; Heu, Jun-Young; Kim, Jung Youn; Chi, Hee-Man; Lee, Se‐Won

doi:10.1007/s00068-022-01940-z

Cited by 4 publications

(8 citation statements)

References 32 publications

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“…Yet, the literature is limited to small case series, mostly without a control group. 9 - 14 Further, no previous study has compared the results of DP, SP, and DFA all together. 9 - 14 One study compared native distal femur fractures with PDFFs, demonstrating satisfactory results in both groups.…”

Section: Discussionmentioning

confidence: 99%

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Double plating is a suitable option for periprosthetic distal femur fracture compared to single plate fixation and distal femoral arthroplasty

Kriechling,

Bowley,

Ross

et al. 2024

Bone Jt Open

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AimsThe purpose of this study was to compare reoperation and revision rates of double plating (DP), single plating using a lateral locking plate (SP), or distal femoral arthroplasty (DFA) for the treatment of periprosthetic distal femur fractures (PDFFs).MethodsAll patients with PDFF primarily treated with DP, SP, or DFA between 2008 and 2022 at a university teaching hospital were included in this retrospective cohort study. The primary outcome was revision surgery for failure following DP, SP, or DFA. Secondary outcome measures included any reoperation, length of hospital stay, and mortality. All basic demographic and relevant implant and injury details were collected. Radiological analysis included fracture classification and evaluation of metaphyseal and medial comminution.ResultsA total of 111 PDFFs (111 patients, median age 82 years (interquartile range (IQR) 75 to 88), 86% female) with 32 (29%) Su classification 1, 37 (34%) Su 2, and 40 (37%) Su 3 fractures were included. The median follow-up was 2.5 years (IQR 1.2 to 5.0). DP, SP, and DFA were used in 15, 66, and 30 patients, respectively. Compared to SP, patients treated with DP were more likely to have metaphyseal comminution (47% vs 14%; p = 0.009), to be low fractures (47% vs 11%; p = 0.009), and to be anatomically reduced (100% vs 71%; p = 0.030). Patients selected for DFA displayed comparable amounts of medial/metaphyseal comminution as those who underwent DP. At a minimum follow-up of two years, revision surgery for failure was performed in 11 (9.9%) cases at a median of five months (IQR 2 to 9): 0 DP patients (0%), 9 SP (14%), and 2 DFA (6.7%) (p = 0.249).ConclusionUsing a strategy of DP fixation in fractures, where the fracture was low but there was enough distal bone to accommodate locking screws, and where there is metaphyseal comminution, resulted in equivalent survival free from revision or reoperation compared to DFA and SP fixation.Cite this article: Bone Jt Open 2024;5(6):489–498.

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Section: Discussionmentioning

confidence: 99%

“…However, clinical evidence for double plating is sparse, with most studies lacking a control group. 9 - 14 No previous study compared double plating to both single plating and DFA.…”

Section: Introductionmentioning

confidence: 99%

Double plating is a suitable option for periprosthetic distal femur fracture compared to single plate fixation and distal femoral arthroplasty

Kriechling,

Bowley,

Ross

et al. 2024

Bone Jt Open

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“… 25 Another finding of their study was that reoperation following LCP was associated with medial comminution. 26 Therefore, the double-locking plate technique may be a viable option in this situation. A previous study reported excellent function (KSS 94 and KSFS 89.5) and fewer complications for very low PPDFFs using double-locked plating.…”

Section: Discussionmentioning

confidence: 99%

“… 27 In addition, dual plating with minimal invasion or intramedullary fibular strut allograft has shown satisfactory outcomes. 26 , 27 However, these were observational studies without control groups. Further research comparing the double-locking plate and DFR for low PDFFs is required.…”

Section: Discussionmentioning

confidence: 99%

Comparison of locking compression plate and distal femoral replacement for periprosthetic distal femoral fractures: a retrospective study

Liang

Gao

et al. 2022

J Int Med Res

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Objective To compare the clinical outcomes of locking compression plate (LCP) and distal femoral replacement (DFR) for periprosthetic distal femoral fractures (PDFFs) after total knee arthroplasty. Methods This retrospective study identified patients with PDFFs in an institutional database between January 2012 and December 2021. Demographic data and clinical outcomes, including postoperative complications, reoperation, 1-year mortality, Knee Society Scores (KSS) and Knee Society Functional Score (KSFS) were analysed. Results In total, 12 patients treated with LCP and six patients treated with DFR were included. There was no significant difference between the LCP and DFR groups in terms of postoperative complications (25.0% versus 33.3%, respectively), reoperation (8.3% versus 0.0%), respectively, 1-year mortality (8.3% versus 16.7%, respectively) or mean ± SD KSS (80.3 ± 8.3 versus 78.0 ± 2.5, respectively). However, the mean ± SD KSFS was significantly better for patients with LCP than for those with DFR (51.8 ± 12.5 versus 37.0 ± 6.7, respectively). Conclusion DFR provides similar clinical outcomes compared with LCP for PDFFs. Patients with advanced age may benefit from DFR to allow early weight bearing.

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“…However, a biomechanical study has indicated that the use of intramedullary allogenic bone strut combined with locking plate provides superior mechanical stability in unstable osteoporotic proximal humeral fractures [ 8 ]. Suh et al also documented that hybrid use of allogenic bone graft can provide global stability in total knee arthroplasty (TKA) supracondylar periprosthetic fracture [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Use of an Intramedullary Allogenic Fibular Strut Bone and Lateral Locking Plate for Distal Femoral Fracture with Supracondylar Comminution in Patients over 50 Years of Age

Peng

et al. 2022

Medicina

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Background and Objectives: Distal femoral fracture is a severe injury that makes surgery challenging, particularly comminuted fractures in the supracondylar region. This study aimed to evaluate the outcomes of distal femoral fracture treated with the application of an intramedullary fibular allogenic bone strut in open reduction and internal fixation (ORIF) with precontoured locking plates in patients over 50 years of age. Materials and Methods: The study retrospectively enrolled 202 patients over 50 years of age with traumatic comminuted distal femoral fracture (AO/OTA 33-A3, 33-C2 and 33-C3) treated with ORIF with a locking plate from January 2016 to December 2019. The two groups were divided into patients who received an intramedullary allogenic bone strut and those who did not. Patients were followed for at least 1 year, with their function scores and radiographic data recorded. Results: A total of 124 patients were recruited, comprising 60 men and 64 women with an average age of 62.4 ± 8.5 years. The 36 patients who had received an intramedullary allogenic fibular bone strut reported lower postoperative pain scores at 1 month and lower postoperative Knee Society Scores (KSS) at 3 months than the control group. The application of an intramedullary allogenic fibular bone strut appeared to be significantly correlated with better 3-month postoperative KSS. Conclusions: The ORIF of distal femoral comminuted fracture with an intramedullary allogenic fibular bone strut can reduce pain and improve knee function in the early stages of postoperative rehabilitation and may reduce the time to union in patients over 50 years of age.

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Use of an intramedullary fibular strut allograft and dual locking plate in periprosthetic fractures above total knee arthroplasty: new application of a well-known treatment method in trauma

Cited by 4 publications

References 32 publications

Double plating is a suitable option for periprosthetic distal femur fracture compared to single plate fixation and distal femoral arthroplasty

Double plating is a suitable option for periprosthetic distal femur fracture compared to single plate fixation and distal femoral arthroplasty

Comparison of locking compression plate and distal femoral replacement for periprosthetic distal femoral fractures: a retrospective study

Use of an Intramedullary Allogenic Fibular Strut Bone and Lateral Locking Plate for Distal Femoral Fracture with Supracondylar Comminution in Patients over 50 Years of Age

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