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. 2024 Jun 12;5(6):489-498.
doi: 10.1302/2633-1462.56.BJO-2023-0145.R1.

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

Philipp Kriechling  1 , Abigail L W Bowley  1 , Lauren A Ross  1 , Matthew Moran  1 , Chloe E H Scott  1   2
Affiliations

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

Philipp Kriechling et al. Bone Jt Open. .

Abstract

Aims: The 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).

Methods: All 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.

Results: A 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).

Conclusion: Using 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.

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Conflict of interest statement

Each author certifies that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. M. Moran reports speaker payments from Stryker, unrelated to this study. C. E. H. Scott reports an institutional grant, teaching payments, and consulting fees from Stryker, and consulting fees from Smith & Nephew and Osstec, all of which are unrelated to this study. C. E. H. Scott also participates on a Data Safety Monitoring Board or Advisory Board for Osstec and Smith & Nephew, and is on the editorial board of The Bone & Joint Journal.

Figures

Fig. 1
Fig. 1
Anteroposterior and lateral views of a periprosthetic distal femur fracture in a 73-year-old female around a standard total knee arthroplasty treated with double plating. The coronal plane CT image confirms no additional sagittal plane split in the distal fragment, and sufficient bone stock to enable fixation. Post fixation radiographs are shown here at seven months.
Fig. 2
Fig. 2
Double plating of a periprosthetic distal femur fracture of a 78-year-old female around a hinged total knee arthroplasty. The anteroposterior and lateral radiographs demonstrate the fracture preoperatively and at five months postoperatively.
Fig. 3
Fig. 3
Double plating for treatment of an interprosthetic distal femur fracture of an 88-year-old female with anatomical reduction and satisfactory healing. The anteroposterior and lateral radiographs and coronal CT demonstrate metaphyseal comminution preoperatively, but no sagittal split. Postoperative radiographs (taken at 47 months) demonstrate union.
Fig. 4
Fig. 4
Kaplan-Meier survival curve of all three groups over a duration of five years. DFA, distal femoral arthroplasty.
See this image and copyright information in PMC

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References

    1. Parvizi J, Jain N, Schmidt AH. Periprosthetic knee fractures. J Orthop Trauma. 2008;22(9):663–671. doi: 10.1097/BOT.0b013e31816ed989. - DOI - PubMed
    1. Tsai SHL, Lin T-Y, Tischler EH, et al. Distal femur fractures have a higher mortality rate compared to hip fractures among the elderly: Insights from the National Trauma Data Bank. Injury. 2021;52(7):1903–1907. doi: 10.1016/j.injury.2021.04.023. - DOI - PubMed
    1. Hull PD, Chou DTS, Lewis S, et al. Knee Fix or Replace Trial (KFORT): a randomized controlled feasibility study. Bone Joint J. 2019;101-B(11):1408–1415. doi: 10.1302/0301-620X.101B11.BJJ-2019-0370.R2. - DOI - PubMed
    1. Wadhwa H, Salazar BP, Goodnough LH, et al. Distal femur replacement versus open reduction and internal fixation for treatment of periprosthetic distal femur fractures: a systematic review and meta-analysis. J Orthop Trauma. 2022;36(1):1–6. doi: 10.1097/BOT.0000000000002141. - DOI - PubMed
    1. Keenan OJF, Ross LA, Magill M, Moran M, Scott CEH. Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures. Knee Surg Relat Res. 2021;33(1):19. doi: 10.1186/s43019-021-00097-0. - DOI - PMC - PubMed