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. 2024 Sep 3;25(1):41.
doi: 10.1186/s10195-024-00782-2.

Distal femoral fractures: periprosthetic fractures have four times more complications than non-periprosthetic fractures and cerclage should be avoided: retrospective analysis of 206 patients

Martin Direder  1 , Cornelia Naß  2 , Julian Ramin Andresen  2 , Theresa Dannenmann  2 , Florian Bur  2 , Stefan Hajdu  2 , Thomas Haider  2
Affiliations

Distal femoral fractures: periprosthetic fractures have four times more complications than non-periprosthetic fractures and cerclage should be avoided: retrospective analysis of 206 patients

Martin Direder et al. J Orthop Traumatol. .

Abstract

Background: Distal femoral fractures account for less than 1% of all fractures. The therapy of choice is usually surgical stabilization. Despite advances in implant development over the past few years, complication rate remains comparatively high. The aim of this study is to analyze our results with plate fixation of distal femoral fractures with a focus on complication and fracture healing rates.

Methods: In this retrospective cohort study, patients (> 18 years) with distal femoral fractures treated at an urban level I trauma center between 2015 and 2022 were analyzed.

Results: In total, 206 patients (167 female, 39 male) with an average age of 75 (SD 16) years were diagnosed with a fracture of the distal femur. One hundred fourteen of these patients were treated surgically by means of plate osteosynthesis. In 13 cases (11.41%), a revision procedure had to be performed. The indication for surgical revision was mechanical failure in eight cases (7.02%) and septic complication in five cases (4.39%). Periprosthetic fractures were more likely to cause complications overall (19.6% versus 4.76%) and further included all documented septic complications. The analysis of modifiable surgical factors in the context of plate osteosynthesis showed higher complication rates for cerclage in the fracture area compared with plate-only stabilizations (44.44% versus 22.22%).

Conclusions: The data show an increased amount of revisions and a significantly higher number of septic complications in the treatment of periprosthetic fractures of the distal femur compared with non-periprosthetic fractures. The detected combination of plates together with cerclage was associated with higher complication rates. Level of evidence Level III retrospective comparative study.

Keywords: Cerclage; Complication rate; Distal femoral fracture; Plate osteosynthesis.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the study population
Fig. 2
Fig. 2
Fracture classifications. Schematic representation of fracture classifications with original X-rays of recorded patients. A AO classification: A1, simple fracture; A2, metaphyseal wedge-shaped fracture; A3, metaphyseal complex fracture; B1, lateral condyle sagittal fracture; B2, medial condyle sagittal fracture; B3, fracture of the anterior part of the femoral condyle; C1, simple intraarticular and metaphyseal fracture; C2, simple intraarticular and comminuted metaphyseal fracture; C3, comminuted fracture; B UCS classification: A, periarticular; B, bed of the implant; C, distant of the implant; D, dividing the bone between two implants; E and F not shown as irrelevant for this fracture area
Fig. 3
Fig. 3
Histogram showing sex-specific, age-related patient distribution
Fig. 4
Fig. 4
X-ray example: measured parameters and example of fracture union
See this image and copyright information in PMC

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