Novel classification system for periprosthetic distal femoral fractures: a consideration for comminution.
Comminuted fracture
Dual plating
Fracture classification
Medial parapatellar approach
Periprosthetic distal femoral fracture
Journal
European journal of orthopaedic surgery & traumatology : orthopedie traumatologie
ISSN: 1432-1068
Titre abrégé: Eur J Orthop Surg Traumatol
Pays: France
ID NLM: 9518037
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
14
11
2022
accepted:
20
12
2022
medline:
27
7
2023
pubmed:
13
1
2023
entrez:
12
1
2023
Statut:
ppublish
Résumé
Comminution is an aspect of periprosthetic distal femoral fractures (PDFFs) that can influence postoperative outcomes and treatment selection, but is not included in current classification systems. We propose a new classification system for PDFFs based on comminution and cortical reads. This study aims to prove its reliability and efficacy to predict fracture severity and guide treatment. A retrospective chart review of patients treated with single or dual locking plates for PDFFs was performed. Two fellowship-trained orthopedic joint reconstruction specialists used available imaging to classify each PDFF as either type 1 (minimal or no comminution allowing for reconstruction of medial and lateral cortices), type 2 (comminution reasonably allowing for reconstruction of either medial or lateral cortex), and type 3 (extensive comminution not allowing reasonable reconstruction of medial or lateral cortex). Each PDFF was then analyzed for radiographic outcomes including lateral distal femoral angle (LDFA) and the posterior distal femoral angle (PDFA). Interobserver reliability assessed by Cohen's Kappa statistic was 0.707, and average intraobserver reliability was 0.843, showing substantial reliability. Type 3 PDFFs had greater varus deformity than type 1 (p = 0.0457) or 2 (0.0198). The proposed classification system accounts for comminution, demonstrates strong interobserver and intraobserver reliability, and can be used to guide treatment in regard to single versus dual plating. Retrospective comparative study, Level IV.
Identifiants
pubmed: 36635567
doi: 10.1007/s00590-022-03468-9
pii: 10.1007/s00590-022-03468-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2541-2546Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.
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