Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosy
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TRAUMA SURGERY
Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Jae‑Ho Lee1 · Ki‑Chul Park1 · Seung‑Jae Lim2 · Kyeu‑Back Kwon2 · Ji Wan Kim3 Received: 1 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Achieving adequate reduction is difficult when performing minimally invasive plate osteosynthesis (MIPO) in elderly patients with simple distal femur fracture. This study aimed to evaluate the elderly patients who had undergone percutaneous wiring-assisted reduction with MIPO for simple distal femur fractures to determine the effect of this technique on reduction quality and fracture union. Materials and methods Between January 2009 and September 2017, 56 patients (56 femurs) with displaced simple distal femur fractures treated with MIPO at three trauma centers were finally enrolled. The MIPO technique with percutaneous cerclage wire reduction was performed in 25 patients (Group A). Among them, 12 patients had a simple spiral metaphyseal fracture (Group A*). In comparison, MIPO without percutaneous cerclage wire reduction was performed in 31 patients (Group B). Among them, seven patients had a simple spiral metaphyseal fracture (Group B*). Medical records containing surgical records were retrospectively reviewed to investigate demographic data, comorbidities, complications, operative time, and fluoroscopic time. Radiographs were evaluated for assessing the quality of the reduction and fracture union. Results The mean fracture union time of Group A* was 21.7 weeks, which was significantly shorter than that of Group B* (28.6 weeks). The mean coronal and sagittal angulation in Group A* was 0.6° and 0.7°, respectively, which were significantly lesser than those in Group B* (2.4° and 3.2°, respectively). Mean translation in Group A* was 1.43 mm, which was significantly shorter than that in Group B* (3.81 mm). Nonunion occurred in two patients in Group B. Conclusion Surgical treatment of simple spiral distal femur fractures with percutaneous cerclage wiring-assisted reduction and the MIPO technique in elderly patients resulted in better reduction and faster union time. Therefore, this technique could be a good solution if used in accordance with the indication. Keywords Simple fracture · Distal femur fracture · Minimally invasive plate osteosynthesis · Percutaneous cerclage wiring
Introduction
* Ki‑Chul Park [email protected] 1
Department of Orthopedic Surgery, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Gyeonggi‑do, South Korea
2
Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
3
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, South Korea
The distal femur fracture of the elderly is mostly caused by low-energy mechanism, and it is the second most common
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