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Journal of Peking University (Health Sciences) ›› 2022, Vol. 54 ›› Issue (6): 1172-1177. doi: 10.19723/j.issn.1671-167X.2022.06.019

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Related factors of revision of distal femoral fractures treated with lateral locking plate

Guo-jin HOU,Fang ZHOU*(),Yun TIAN,Hong-quan JI,Zhi-shan ZHANG,Yan GUO,yang LV,Zhong-wei YANG   

  1. Department of Orthopaedic Surgery, Peking University Third Hospital, Beijing 100191, China
  • Received:2020-03-17 Online:2022-12-18 Published:2022-12-19
  • Contact: Fang ZHOU E-mail:zhouf@bjmu.edu.cn

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Abstract:

Objective: To analyze the factors related to the need for revision surgery due to nonunion or internal fixation failure after the treatment of distal femoral fracture with lateral locking plate (LLP). Methods: Retrospective analysis was made of the clinical data of 130 cases with distal femoral fracture treated in our hospital from March 2005 to March 2019. SPSS 17.0 software (univariate analysis and Logistic regression analysis) was used to analyze the general condition [gender, age, body mass index (BMI), comorbidities, smoking history], injury related factors (energy of injury, open or closed injury, AO/OTA classification of fracture, fracture area distribution), operation related factors (operation time, reduction quality, postoperative infection) and construct characteristics of internal fixation. Results: Twelve of 130 patients who were included in the study underwent revisional surgery, with a revision rate 9.2%. Univariate analysis showed that there were significant differences in age, BMI, AO/OTA classification, fracture area distribution, operation time, reduction quality, length of plate/fracture area, length of plate/fracture area above condylar between the two groups (P < 0.05). Logistic regression analysis showed that AO/OTA classification (A3), supracondylar involved fracture, operation time, reduction quality and the length of the plate/fracture area above the condylar were the possible related factors (P < 0.05). Destruction of the medial support ability of the femur in comminuted type A3 fracture, supra-condylar cortex area fracture involvement, increase of the bending stress of the LLP due to poor fracture reduction quality, damage of the blood supply of fracture end due to long-time operation, and stress concentration caused by insufficient length of plate might be risk factors of revisional operation after the treatment of distal femoral fracture with LLP. For the patients who needed revision after LLP treatment, additional use of medial minimally invasive plate fixation and autologous bone transplantation, change to intramedullary nail fixation were commonly used clinical treatment strategies. Conclusion: AO/OTA classification (A3), supracondylar involved fracture, long operation time, poor reduction quality and the length of the plate/fracture area above the condylar were the possible predictive factors of the revision in distal femoral fractures treated with lateral locking plate. The appropriate application of the locking plate and operation strategy are the key to reduce the revision rate in distal femoral fractures.

Key words: Distal femoral fracture, Locking plate, Lateral, Revision, Predictive factors

CLC Number: 

  • R683.4

Figure 1

Fracture area was divided into Ⅰ and Ⅱ according to the multiple of the width of femoral condyle Ⅰ, condylar, Ⅱ, supracondylar."

Figure 2

Internal fixation structure L1, length of plate; L2, length of fracture area; L3, length of plate above condylar screw; L4, distance between proximal part of fracture and screw; L5, working length of proximal plate."

Table 1

Univariate analysis of revision in distal femoral fractures treated with lateral locking plate"

Factors Non-revision (n=118) Revision (n=12) Statistics P value
Male/female, n 26/92 4/8 χ2=0.783 0.376
Age/years, ${\bar x}$±s 60.7±15.2 69.1±11.0 t=-2.428 0.028
BMI/(kg/m2), ${\bar x}$±s 24.9±3.6 26.9±2.4 t=-2.661 0.017
Smoking (yes/no), n 8/110 1/11 χ2=0.041 0.840
Diabetes (yes/no)，n 28/90 2/10 χ2=0.306 0.580
Use of corticosteroids (yes/no)，n 6/112 0/12 0.553
Energy of injury (low/high)，n 64/54 10/2 χ2=3.761 0.052
Open/closed fracture, n 12/106 0/12 χ2=1.344 0.246
AO/OTA fracture type (A2/A3/C1/C2)，n 26/40/10/42 0/10/0/2 χ2=11.735 0.008
Supracondylar involved (yes/no)，n 56/62 12/0 χ2=12.054 0.001
Quality of reduction (good/poor)，n 85/33 5/7 χ2=4.715 0.030
Length of surgery/min, ${\bar x}$±s 144.0±46.6 174.8±58.4 t=2.133 0.035
R1, ${\bar x}$±s 3.0±1.4 2.4±0.5 t=3.375 0.002
R2, ${\bar x}$±s 3.2±1.2 2.3±0.5 t=2.507 0.013
R3, ${\bar x}$±s 0.35±0.29 0.19±0.17 t=1.875 0.066
D, M (Min, Max) 0.57 (0.31, 1) 0.56 (0.45, 0.78) z=-0.567 0.570

Table 2

Multivariate logistic regression analysis of related factors of revision"

Predictors Regression coefficient Standard error Wald χ2 P value OR OR 95%CI
Type of fracture 3.570 1.175 9.232 0.002 35.511 3.551-355.159
Distribution of fracture 3.316 1.224 7.339 0.007 0.036 0.003-0.400
Length of surgery 0.021 0.009 5.613 0.018 1.021 1.004-1.039
Reduction quality 1.557 0.815 3.648 0.036 4.745 0.960-23.450
R2 -1.284 0.593 4.691 0.030 0.277 0.087-0.885
Constant -4.328 2.184 3.926 0.048 0.013

Figure 3

A 72 years old female patient suffered from the left distal femur fracture caused by fall A, B, preoperative anterior-posterior and lateral X-ray; C, postoperative X-ray after the 1st operation; D, internal fixation failure due to nonunion 17 months after operation; E, F, fracture healing 7 months after revision with intramedullary nail."

Figure 4

A 76 years old female patient suffered from the right distal femur fracture caused by fall A, B, preoperative anterior-posterior and lateral X-ray; C, postoperative X-ray after the 1st operation; D, nonunion 12 months after operation; E, F, fracture healing 5 months after revision with medial plate addition and bone graft."

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