Periprosthetic distal femur fractures: current concepts.

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Abstract

[Indexed for MEDLINE] 17. Eur J Orthop Surg Traumatol. 2023 Jul;33(5):2081-2089. doi: 10.1007/s00590-022-03398-6. Epub 2022 Oct 6. Early peri-implant fractures after distal femur fracture locked plating? Meyer AP(1), Large TM(2)(3). Author information: (1)Emory University Department of Orthopedic Surgery, Grady Memorial Hospital, Atlanta, GA, 30301, USA. (2)Emory University Department of Orthopedic Surgery, Grady Memorial Hospital, Atlanta, GA, 30301, USA. tmlarge@emory.edu. (3)Mission Hospital, Orthopedic Trauma Services, Asheville, NC, USA. tmlarge@emory.edu. PURPOSE: To report the peri-implant fracture rates after locked plating of distal femur fractures and examine risk factors. METHODS: Over a 7 year period, 89 AO/OTA 33A/C distal femur fractures were identified and reviewed. After excluding treatment with intramedullary nails, age under 50, those with the proximal femur protected, or those without 6 months of follow-up, 42 distal femur fractures in 41 patients, mean age 72.3 were studied. All were treated with lateral locked plating of distal femur fractures. The details of the constructs were recorded. Mean follow-up was 562 days (18.7 months). RESULTS: 3/42 were open injuries, 9/42 were type C, 16/42 were type A, and 17 were periprosthetic above a knee arthroplasty. Two patients were treated with a dynamic plating construct using all far-cortical locking (FCL) screws in the diaphysis. 40 patients were treated with a variety of non-dynamic diaphyseal constructs including locking, non-locking, and four with 1-2 FCL screws distally. There was one asymptomatic nonunion. 2/2 patients in the dynamically plated group experienced a peri-implant fracture versus 1/40 in the non-dynamically plated group (p = 0.001). 3/9 with an all-locked construct versus 0/25 patients with a most proximal non-locking screw experienced a fracture. CONCLUSIONS: The overall peri-implant fracture risk was 7.1% (3/42), 3/17 patients with a locking screw most proximal experienced a peri-implant fracture, 3/9 with an all-locking construct, and 2/2 patients with a dynamic construct experienced a fracture. These findings merit additional clinical and biomechanical study. © 2022. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature. DOI: 10.1007/s00590-022-03398-6