The effect of coronal plane angulation on patient reported outcome measures of operatively treated distal femur fractures: A multi-center prospective evaluation

The effect of coronal plane angulation on patient reported outcome measures of operatively treated distal femur fractures: A multi-center prospective evaluation

The goal of this trial was to determine whether coronal plane angulation affects functional and clinical outcomes after the fixation of distal femur fractures. Multicenter, randomized controlled trial 20 academic trauma centers 156 patients with distal femur fractures were enrolled. 123 patients wer...

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Bibliographic Details
Published in:Injury Vol. 55; no. 8; p. 111597
Main Authors: Dunbar, R.P., Cooke, M., Tornetta, P., Born, C.T., Collinge, C., Egol, K.A., Ertl, J.P., Friess, D.M., Humphrey, C.A., Jones, C.B., Mullis, B.H., Ostrum, R.F., Perez, E., Phieffer, L., Ricci, W.M., Sagi, H.C., Schmidt, A.H., Sems, A., Siegel, J., Teague, D.C., Zonno, A.
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01-08-2024
Subjects:
Adult
Aged
Bone Plates
Coronal plane alignment
Distal femur fracture
Female
Femoral Fractures, Distal - diagnostic imaging
Femoral Fractures, Distal - surgery
Fracture Fixation, Internal - methods
Fracture Fixation, Intramedullary - methods
Fracture Healing
Humans
Male
Middle Aged
Patient Reported Outcome Measures
Patient reported outcomes
Prospective Studies
Radiography
Recovery of Function
Treatment Outcome
Walking - physiology
Distal femur fracture
Patient reported outcomes
Coronal plane alignment
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Summary:The goal of this trial was to determine whether coronal plane angulation affects functional and clinical outcomes after the fixation of distal femur fractures. Multicenter, randomized controlled trial 20 academic trauma centers 156 patients with distal femur fractures were enrolled. 123 patients were followed 12 months. There was clinical outcome data available for 105 patients at 3 months, 95 patients at 6 months and 81 patients at one year. Lateral locked plating or retrograde intramedullary nailing Radiographic alignment, functional scoring including SMFA, Bother Index, and EQ-5D. Clinical scoring of walking ability, need for ambulatory support and ability to manage stairs. At 3 months, there was no difference between groups (varus, neutral or valgus) with respect to any of the clinical functional outcome scores measured. At 6 months, compared to those with neutral alignment, patients with varus angulation had a worse Stair Climbing score (4.33 vs. 2.91, p = 0.05). At 12 months, the average patient with neutral or valgus alignment needed less ambulatory support than the average patient in varus. Walking distance ability was no different between the groups at any time point. With respect to the validated patient-based outcome scores, we found no statistical difference in in the SMFA, Bother, or EQ-5D between patients with valgus or varus mal-alignment and those with neutral alignment at any time point (p > 0.05). Regardless of coronal angulation, the SMFA trended towards lower (improved) scores over time, while EQ-5D scores for patients with varus angulation did not improve over time. Valgus angulation and neutral angulation may be better tolerated in terms of clinical outcomes like stair climbing and need for ambulatory support than varus angulation, though patient reported outcome measures like the SMFA, Bother Index and EQ-5D show no statistical significance. Most patients with distal femur fractures tend to improve during the first year after injury but many remain significantly affected at 12 months post injury.
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ISSN:0020-1383
1879-0267
1879-0267
DOI:10.1016/j.injury.2024.111597