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Original Article Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion
Soo young Jeong, Jae Ho Lee, Ki Chul Park
Journal of Musculoskeletal Trauma 2019;32(4):188-195.
DOI: https://doi.org/10.12671/jkfs.2019.32.4.188
Published online: October 31, 2019
Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea. kcpark@hanyang.ac.kr

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Abstract

PURPOSE
Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (age≥60) and to determine the risk factors related witht he occurrence of nonunion.
MATERIALS AND METHODS
This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion.
RESULTS
The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045).
CONCLUSION
The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.


J Korean Fract Soc. 2019 Oct;32(4):188-195. Korean.
Published online Oct 28, 2019.
https://doi.org/10.12671/jkfs.2019.32.4.188
Copyright © 2019 The Korean Fracture Society. All rights reserved.
Original Article

Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion

Soo-young Jeong, M.D., Jae-Ho Lee, M.D. and Ki-Chul Park, M.D., Ph.D.
    • Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Korea.
  • Correspondence to: Ki-Chul Park, M.D., Ph.D. Department of Orthopedic Surgery, Hanyang University Guri Hospital, 153 Gyeongchun-ro, Guri 11923, Korea. Tel: +82-31-560-2317, Fax: +82-31-557-8781, Email: kcpark@hanyang.ac.kr
Received September 23, 2019; Revised September 30, 2019; Accepted September 30, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (age≥60) and to determine the risk factors related witht he occurrence of nonunion.

Materials and Methods

This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion.

Results

The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045).

Conclusion

The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.

Keywords
Distal femur fracture, Periprosthetic fracture, Nonunion, Minimally invasive plate osteosynthesis technique technique

Figures

Fig. 1
Flow chart of the study population after exclusion of patients. ISS: injury severity score, IM: intramedullary, Fx.: fracture.

Fig. 2
A 76-year-old woman slipped down and developed a right periprosthtic distal femur fracture (A, B). We performed open reduction and internal affixation with dual plates (C, D), but after 16 months there was no sign of bone union (E, F). Although there were some fracture gaps and slightly shorter plate lengths, oligotrophic nonunion occurred and not hypertrophic nonunion. From here, we performed reoperation with changing plates with using autogenous iliac bone grafting, and union was then achieved (G, H).

Tables

Table 1
Baseline Characteristics and Demographics

Table 2
Selected Comorbidities, Postoperative Outcomes, Mortality Rates and Complications

Table 3
Comparison between the Union and Nonunion Groups

Table 4
Multiple Logistic Regression Analysis of Nonunion

Notes

Financial support:None.

Conflict of interests:None.

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    Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion
    J Korean Fract Soc. 2019;32(4):188-195.   Published online October 31, 2019
    DOI: https://doi.org/10.12671/jkfs.2019.32.4.188
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