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Multicenter Study
. 2023 Apr 1;37(4):168-174.
doi: 10.1097/BOT.0000000000002516.

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

Christopher Lee  1 , Dane Brodke  1 , Nathan O'Hara  2 , Sai Devana  1 , Adolfo Hernandez  1 , Cynthia Burke  2 , Jayesh Gupta  2 , Natasha McKibben  2 , Robert O'Toole  2 , John Morellato  3 , Hunter Gillon  3 , Murphy Walters  3 , Colby Barber  4 , Paul Perdue  4 , Graham Dekeyser  5 , Lillia Steffenson  5 , Lucas Marchand  5 , Marshall James Fairres  6 , Loren Black  7 , Zachary Working  7 , Erika Roddy  8 , Ashraf El Naga  8 , Matthew Hogue  9 , Trevor Gulbrandsen  9 , Omar Atassi  10 , Thomas Mitchell  10 , Stephen Shymon  6
Affiliations
Multicenter Study

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

Christopher Lee et al. J Orthop Trauma. .

Abstract

Objectives: To identify modifiable and nonmodifiable risk factors for reoperation to promote union after distal femur fracture.

Design: Multicenter retrospective cohort study.

Setting: Ten Level-I trauma centers.

Patients/participants: Patients with OTA/AO 33A or C distal femur fractures (n = 1111).

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, intra-articular 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.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Conflict of interest statement

The authors report no conflict of interest.

References

    1. Henderson CE, Lujan TJ, Kuhl LL, et al. 2010 mid-America Orthopaedic Association Physician in Training Award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res. 2011;469:1757–1765.
    1. Ricci WM, Loftus T, Cox C, et al. Locked plates combined with minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma. 2006;20:190–196.
    1. Ricci WM, Streubel PN, Morshed S, et al. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014;28:83–89.
    1. Weight M, Collinge C. Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma. 2004;18:503–508.
    1. Streubel PN, Gardner MJ, Morshed S, et al. Are extreme distal periprosthetic supracondylar fractures of the femur too distal to fix using a lateral locked plate? J Bone Joint Surg Br. 2010;92:527–534.

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