TY - JOUR
T1 - Risk Factors for Reoperation to Promote Union in 1111 Distal Femur Fractures
AU - Lee, Christopher
AU - Brodke, Dane
AU - O'Hara, Nathan
AU - Devana, Sai
AU - Hernandez, Adolfo
AU - Burke, Cynthia
AU - Gupta, Jayesh
AU - McKibben, Natasha
AU - O'Toole, Robert
AU - Morellato, John
AU - Gillon, Hunter
AU - Walters, Murphy
AU - Barber, Colby
AU - Perdue, Paul
AU - Dekeyser, Graham
AU - Steffenson, Lillia
AU - Marchand, Lucas
AU - Fairres, Marshall James
AU - Black, Loren
AU - Working, Zachary
AU - Roddy, Erika
AU - El Naga, Ashraf
AU - Hogue, Matthew
AU - Gulbrandsen, Trevor
AU - Atassi, Omar
AU - Mitchell, Thomas
AU - Shymon, Stephen
N1 - Publisher Copyright:
© 2023 by the Author(s).
PY - 2023/4/1
Y1 - 2023/4/1
N2 - Objectives:To identify modifiable and nonmodifiable risk factors for reoperation to promote union after distal femur fracture.Design:Multicenter retrospective cohort study.Setting:Ten Level-I trauma centers.Patients/Participants:Patients with OTA/AO 33A or C distal femur fractures (n = 1111).Intervention:Surgical fixation of distal femur fracture. Fixation constructs were classified as lateral plate, dual plate, nail, or nail plate combination.Main Outcome Measurements:The outcome of interest was unplanned reoperation to promote union.Results:There was an 11% (121/1111) rate of unplanned reoperation to promote union. In the multivariate analysis, predictive factors included body mass index [odds ratio (OR) = 1.18; 95% confidence interval (CI), 1.06-1.32; P < 0.01], intra-articular fracture (OR = 1.57; 95% CI, 1.01-2.45; P = 0.04), type III open injury (OR = 2.29; 95% CI, 1.41-3.72; P < 0.01), the presence of medial comminution (OR = 1.85; 95% CI, 1.14-3.06; P = 0.01), and medial translation on postoperative radiographs (OR = 1.23 per one 10th of condylar width; 95% CI, 1.01-1.48; P = 0.03). Construct type was not significantly predictive.Conclusions:Eleven percent of distal femur fractures underwent unplanned reoperation to promote union. Body mass index, intra-articular fracture, type III open injury, medial comminution, and medial translation on postoperative radiographs were predictive factors. Construct type was not associated with unplanned reoperation; however, this conclusion was limited by small numbers in the dual plate and nail plate groups.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
AB - Objectives:To identify modifiable and nonmodifiable risk factors for reoperation to promote union after distal femur fracture.Design:Multicenter retrospective cohort study.Setting:Ten Level-I trauma centers.Patients/Participants:Patients with OTA/AO 33A or C distal femur fractures (n = 1111).Intervention:Surgical fixation of distal femur fracture. Fixation constructs were classified as lateral plate, dual plate, nail, or nail plate combination.Main Outcome Measurements:The outcome of interest was unplanned reoperation to promote union.Results:There was an 11% (121/1111) rate of unplanned reoperation to promote union. In the multivariate analysis, predictive factors included body mass index [odds ratio (OR) = 1.18; 95% confidence interval (CI), 1.06-1.32; P < 0.01], intra-articular fracture (OR = 1.57; 95% CI, 1.01-2.45; P = 0.04), type III open injury (OR = 2.29; 95% CI, 1.41-3.72; P < 0.01), the presence of medial comminution (OR = 1.85; 95% CI, 1.14-3.06; P = 0.01), and medial translation on postoperative radiographs (OR = 1.23 per one 10th of condylar width; 95% CI, 1.01-1.48; P = 0.03). Construct type was not significantly predictive.Conclusions:Eleven percent of distal femur fractures underwent unplanned reoperation to promote union. Body mass index, intra-articular fracture, type III open injury, medial comminution, and medial translation on postoperative radiographs were predictive factors. Construct type was not associated with unplanned reoperation; however, this conclusion was limited by small numbers in the dual plate and nail plate groups.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
KW - distal femur
KW - intramedullary nail
KW - multicenter
KW - plate fixation
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U2 - 10.1097/BOT.0000000000002516
DO - 10.1097/BOT.0000000000002516
M3 - Article
C2 - 36379069
AN - SCOPUS:85150357849
SN - 0890-5339
VL - 37
SP - 168
EP - 174
JO - Journal of orthopaedic trauma
JF - Journal of orthopaedic trauma
IS - 4
ER -