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. 2022 Dec 2;30(spe2):e256896.
doi: 10.1590/1413-785220223002e256896. eCollection 2022.

DISTAL FEMORAL FRACTURES FROM HIGH-ENERGY TRAUMA: A RETROSPECTIVE REVIEW OF COMPLICATION RATE AND RISK FACTORS

Micael de Mesquita Paiva  1 , Daniel Peixoto Leal  1 , Paulo Ken Kuroki  1 , Barbara Garcia Barroso  1 , Marco Antonio Avalos Reyna  1 , Marcos de Camargo Leonhardt  1 , Jorge Dos Santos Silva  1 , Kodi Edson Kojima  1
Affiliations

DISTAL FEMORAL FRACTURES FROM HIGH-ENERGY TRAUMA: A RETROSPECTIVE REVIEW OF COMPLICATION RATE AND RISK FACTORS

Micael de Mesquita Paiva et al. Acta Ortop Bras. .

Abstract
in English, Portuguese

Objective: Determine complications' incidence and risk factors in high-energy distal femur fractures fixed with a lateral locked plate.

Methods: Forty-seven patients were included; 87.2% were male, and the average age was 38.9. The main radiographic parameters collected were distal lateral femoral angle (DFA), distal posterior femoral angle (DPLF), comminution length, plate length, screw working length, bone loss, and medial contact after reduction and plate-bone contact, location of callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection.

Results: Complex C2 and C3 fractures accounted for 85.1% of cases. Open fractures accounted for 63.8% of cases. The mean AFDL and AFDP were 79.8 4.0 and 79.3 6.0, respectively. The average total proximal and distal working lengths were 133.3 42.7, 60.4 33.4, and 29.5 21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p = 0.005). The nonunion rate was 19.1%, with longer working length (p = 0.035) and higher PDFA (p = 0.001) as risk factors. The site of callus formation also influenced pseudoarthrosis (p = 0.034).

Conclusion: High-energy distal femoral fractures have a higher incidence of pseudoarthrosis and infection. Nonunion has greater working length, greater AFDL, and absence of callus formation on the medial and posterior sides as risk factors. The risk factor for infection was an open fracture. Level of Evidence III; Retrospective Cohort Study .

Objetivos: Determinar a incidência e os fatores de risco de complicações nas fraturas de alta energia das fraturas distais do fêmur fixadas com placa bloqueada lateral.

Métodos: Foram incluídos 47 pacientes, sendo 87,2% homens e idade média de 38,9 anos. Os principais parâmetros radiográficos coletados foram o ângulo femoral distal lateral (AFDL), ângulo femoral distal posterior (AFDP), comprimento da cominuição, comprimento da placa, comprimento de trabalho dos parafusos, perda óssea, contato medial após a redução e contato placa-osso, localização da formação do calo e falha do implante. As complicações registradas foram não união, falha do implante e infecção.

Resultados: Fraturas complexas C2 e C3 representaram 85,1% dos casos. As fraturas expostas corresponderam a 63,8% dos casos. O AFDL e AFDP médios foram 79,8° ± 4,0° e 79,3°± 6,0°, respectivamente. Os comprimentos de trabalho total, proximal e distal médios foram 133,3 ± 42,7, 60,4 ± 33,4 e 29,5 ± 21,8 mm, respectivamente. A taxa de infecção foi de 29,8% e o único fator de risco foi a fratura exposta (p = 0,005). A taxa de não união foi de 19,1%, com maior comprimento de trabalho (p = 0,035) e maior PDFA (p = 0,001) como fatores de risco. O local de formação do calo também influenciou na pseudoartrose (p = 0,034).

Conclusões: Fraturas distais do fêmur de alta energia apresentam maior incidência de pseudoartrose e infecção. A não união tem como fatores de risco maior comprimento de trabalho, maior AFDL e ausência de formação de calo nos lados medial e posterior. O fator de risco para infecção foi a fratura exposta. Nível de evidência III; Estudo de Coorte Retrospectivo .

Keywords: Femoracetabular Impingement; Femoral Fractures; Pseudarthrosis; Shock, Traumatic.

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Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1
Figure 1. Radiographic measurements. - A- Lateral distal femoral angle (LDFA), B- Posterior distal femoral angle (PDFA), C- Total working length, proximal and distal working length.
See this image and copyright information in PMC

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