Immediate weight-bearing is safe following lateral locked plate fixation of periprosthetic distal femoral fractures

Keenan Oisin J. F.; Ross Lauren A.; Magill Matthew; Moran Matthew; Scott Chloe E. H.

doi:10.1186/s43019-021-00097-0

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저자정보: Keenan Oisin J. F. (Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA UK) Ross Lauren A. (Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA UK) Magill Matthew (Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA UK) Moran Matthew (Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA UK) Scott Chloe E. H. (Royal Infirmary of Edinburgh 51 Little France Crescent Edinburgh EH16 4SA UK)

저널정보: 대한슬관절학회 Knee Surgery and Related Research Knee Surgery and Related Research 제33권

발행연도: 2021.9

수록면: 19 - 19 (1page)

DOI: 10.1186/s43019-021-00097-0

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This study aimed to determine whether unrestricted weight-bearing as tolerated (WBAT) following lateral locking plate (LLP) fixation of periprosthetic distal femoral fractures (PDFFs) is associated with increased failure and reoperation, compared with restricted weight-bearing (RWB).In a retrospective cohort study of consecutive patients with unilateral PDFFs undergoing LLP fixation, patients prescribed WBAT were compared with those prescribed 6?weeks of RWB. The primary outcome measure was reoperation. Kaplan?Meier and Cox multivariable analyses were performed. There were 43 patients (mean age 80.9?±?11.7?years, body mass index 26.8?±?5.7?kg/m 2 and 86.0% female): 28 WBAT and 15 RWB. There were more interprosthetic fractures in the RWB group ( p =?0.040). Mean follow-up was 3.8?years (range 1.0?10.4). Eight patients (18.6%) underwent reoperation. Kaplan?Meier analysis demonstrated no difference in 2-year survival between WBAT (80.6%, 95% CI 65.3?95.9) and RWB (83.3%, 95% CI 62.1?100.0; p =?0.54). Cox analysis showed increased reoperation risk with medial comminution (hazard ratio 10.7, 95% CI 1.5?80; p =?0.020) and decreased risk with anatomic reduction (hazard ratio 0.11, 95% CI 0.01?1.0; p =?0.046). Immediate weight-bearing did not significantly affect the risk of reoperation compared with RWB (relative risk 1.03, 95% CI 0.61?1.74; p =?0.91). LLP fixation failure was associated with medial comminution and non-anatomic reductions, not with postoperative weight-bearing. Medial comminution should be managed with additional fixation. Weight-bearing restrictions additional to this appear unnecessary and should be avoided.

#Periprosthetic fracture #Distal femur fracture #Lateral locking plate fixation #Weight-bearing

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