Distal femoral fractures: periprosthetic fractures have four times more complications than non-periprosthetic fractures and cerclage should be avoided: retrospective analysis of 206 patients

• Published in: Journal of orthopaedics and traumatology Vol. 25; no. 1; pp. 41 - 12
• Main Authors: Direder, Martin, Naß, Cornelia, Andresen, Julian Ramin, Dannenmann, Theresa, Bur, Florian, Hajdu, Stefan, Haider, Thomas
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 03-09-2024; Springer Nature B.V; SpringerOpen
• Subjects: Age; Aged; Aged, 80 and over; Bone healing; Bone Plates; Cerclage; Classification; Cohort analysis; Comparative studies; Complication rate; Conservative Orthopedics; Diabetes; Distal femoral fracture; Female; Femoral Fractures - surgery; Femoral Fractures, Distal; Femur; Fracture Fixation, Internal - adverse effects; Fracture Fixation, Internal - methods; Fracture Healing; Fractures; Humans; Male; Mechanical failure; Medicine; Medicine & Public Health; Middle Aged; Original; Original Article; Orthopedics; Osteoporosis; Osteosynthesis; Patients; Periprosthetic Fractures - etiology; Periprosthetic Fractures - surgery; Plate osteosynthesis; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Reoperation; Retrospective Studies; Revisions; Rheumatism; Rheumatology; Sports Medicine; Statistical analysis; Surgery; Surgical Orthopedics; Trauma; Trauma centers; Traumatic Surgery; Complication rate; Cerclage; Distal femoral fracture; Plate osteosynthesis
• ISSN: 1590-9999; 1590-9921; 1590-9999
• DOI: 10.1186/s10195-024-00782-2

Background
Distal femoral fractures account for less than 1% of all fractures. The therapy of choice is usually surgical stabilization. Despite advances in implant development over the past few years, complication rate remains comparatively high. The aim of this study is to analyze our results with plate fixation of distal femoral fractures with a focus on complication and fracture healing rates.
Methods
In this retrospective cohort study, patients (> 18 years) with distal femoral fractures treated at an urban level I trauma center between 2015 and 2022 were analyzed.
Results
In total, 206 patients (167 female, 39 male) with an average age of 75 (SD 16) years were diagnosed with a fracture of the distal femur. One hundred fourteen of these patients were treated surgically by means of plate osteosynthesis. In 13 cases (11.41%), a revision procedure had to be performed. The indication for surgical revision was mechanical failure in eight cases (7.02%) and septic complication in five cases (4.39%). Periprosthetic fractures were more likely to cause complications overall (19.6% versus 4.76%) and further included all documented septic complications. The analysis of modifiable surgical factors in the context of plate osteosynthesis showed higher complication rates for cerclage in the fracture area compared with plate-only stabilizations (44.44% versus 22.22%).
Conclusions
The data show an increased amount of revisions and a significantly higher number of septic complications in the treatment of periprosthetic fractures of the distal femur compared with non-periprosthetic fractures. The detected combination of plates together with cerclage was associated with higher complication rates.
Level of evidence
Level III retrospective comparative study.