Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures

Joon Woo Kim, Chang Wug Oh, Jong-Keon Oh, Il Hyung Park, Hee Soo Kyung, Kyeong Hyeon Park, Seong Dae Yoon, Seong Min Kim

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction Although minimally invasive plate osteosynthesis (MIPO) is a preferred operative treatment for fractures of the distal femur, malalignment is a significant concern because of indirect reduction of the fracture. The purpose of this study, therefore, was to evaluate radiologic alignment after MIPO for distal femoral fractures. Patients and methods Of the 138 patients with fracture of the distal femur who underwent MIPO, we enrolled 51 patients in whom bilateral rotational alignment could be assessed by postoperative computed tomography (CT). The patients included 32 men and 19 women, with a mean age of 54.3 years. Thirteen patients had femoral shaft fractures (according to the AO/OTA classification: 32-A, n = 2; 32-B, n = 6; 32-C, n = 5), whereas 38 patients had distal femoral fractures (33-A, n = 7; 33-C, n = 31). Coronal and sagittal alignments were assessed using simple radiography, whereas rotational alignment was assessed using CT. According to the difference between the affected and unaffected sides, we divided the patients into satisfactory and unsatisfactory groups (reference point of 8°, using Handolin's classification). Thereafter, we determined which factors can lead to malalignment, including fracture location (distal femoral shaft fracture or metaphyseal fracture), fracture pattern (simple fracture, n = 15; complex fractures, n = 36 patients), coronal and sagittal alignments, and combined ipsilateral long bone fractures. Results Coronal and sagittal alignment were satisfactory in 96.2% (average, 2.8°) and 98% (average, 2.2°), respectively, whereas the rotational alignment was satisfactory in 56.9% of patients. Leg length discrepancy was satisfactory in 92.3% of the patients (average, 10.9 mm). Concerning rotational malalignment, an unsatisfactory result was obtained in 48.6% of subjects with complex fractures and 26.7% of subjects with simple fractures (p = 0.114). No significant correlation was noted between the angular deformity in the coronal and sagittal planes and the degree of rotational alignment (p = 0.607 and 0.774, respectively). Conclusions Regardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after MIPO for fractures of the distal femur.

Original languageEnglish
Pages (from-to)751-757
Number of pages7
JournalInjury
Volume48
Issue number3
DOIs
Publication statusPublished - 2017 Mar 1

Fingerprint

Femoral Fractures
Femur
Tomography
Internal Fracture Fixation
Fracture Fixation
Bone Fractures
Radiography
Leg

Keywords

  • Distal femoral fracture
  • Minimally invasive plate osteosynthesis
  • Rotational malalignment

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Kim, J. W., Oh, C. W., Oh, J-K., Park, I. H., Kyung, H. S., Park, K. H., ... Kim, S. M. (2017). Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures. Injury, 48(3), 751-757. https://doi.org/10.1016/j.injury.2017.01.019

Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures. / Kim, Joon Woo; Oh, Chang Wug; Oh, Jong-Keon; Park, Il Hyung; Kyung, Hee Soo; Park, Kyeong Hyeon; Yoon, Seong Dae; Kim, Seong Min.

In: Injury, Vol. 48, No. 3, 01.03.2017, p. 751-757.

Research output: Contribution to journalArticle

Kim, JW, Oh, CW, Oh, J-K, Park, IH, Kyung, HS, Park, KH, Yoon, SD & Kim, SM 2017, 'Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures', Injury, vol. 48, no. 3, pp. 751-757. https://doi.org/10.1016/j.injury.2017.01.019
Kim, Joon Woo ; Oh, Chang Wug ; Oh, Jong-Keon ; Park, Il Hyung ; Kyung, Hee Soo ; Park, Kyeong Hyeon ; Yoon, Seong Dae ; Kim, Seong Min. / Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures. In: Injury. 2017 ; Vol. 48, No. 3. pp. 751-757.
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abstract = "Introduction Although minimally invasive plate osteosynthesis (MIPO) is a preferred operative treatment for fractures of the distal femur, malalignment is a significant concern because of indirect reduction of the fracture. The purpose of this study, therefore, was to evaluate radiologic alignment after MIPO for distal femoral fractures. Patients and methods Of the 138 patients with fracture of the distal femur who underwent MIPO, we enrolled 51 patients in whom bilateral rotational alignment could be assessed by postoperative computed tomography (CT). The patients included 32 men and 19 women, with a mean age of 54.3 years. Thirteen patients had femoral shaft fractures (according to the AO/OTA classification: 32-A, n = 2; 32-B, n = 6; 32-C, n = 5), whereas 38 patients had distal femoral fractures (33-A, n = 7; 33-C, n = 31). Coronal and sagittal alignments were assessed using simple radiography, whereas rotational alignment was assessed using CT. According to the difference between the affected and unaffected sides, we divided the patients into satisfactory and unsatisfactory groups (reference point of 8°, using Handolin's classification). Thereafter, we determined which factors can lead to malalignment, including fracture location (distal femoral shaft fracture or metaphyseal fracture), fracture pattern (simple fracture, n = 15; complex fractures, n = 36 patients), coronal and sagittal alignments, and combined ipsilateral long bone fractures. Results Coronal and sagittal alignment were satisfactory in 96.2{\%} (average, 2.8°) and 98{\%} (average, 2.2°), respectively, whereas the rotational alignment was satisfactory in 56.9{\%} of patients. Leg length discrepancy was satisfactory in 92.3{\%} of the patients (average, 10.9 mm). Concerning rotational malalignment, an unsatisfactory result was obtained in 48.6{\%} of subjects with complex fractures and 26.7{\%} of subjects with simple fractures (p = 0.114). No significant correlation was noted between the angular deformity in the coronal and sagittal planes and the degree of rotational alignment (p = 0.607 and 0.774, respectively). Conclusions Regardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after MIPO for fractures of the distal femur.",
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AU - Kim, Joon Woo

AU - Oh, Chang Wug

AU - Oh, Jong-Keon

AU - Park, Il Hyung

AU - Kyung, Hee Soo

AU - Park, Kyeong Hyeon

AU - Yoon, Seong Dae

AU - Kim, Seong Min

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N2 - Introduction Although minimally invasive plate osteosynthesis (MIPO) is a preferred operative treatment for fractures of the distal femur, malalignment is a significant concern because of indirect reduction of the fracture. The purpose of this study, therefore, was to evaluate radiologic alignment after MIPO for distal femoral fractures. Patients and methods Of the 138 patients with fracture of the distal femur who underwent MIPO, we enrolled 51 patients in whom bilateral rotational alignment could be assessed by postoperative computed tomography (CT). The patients included 32 men and 19 women, with a mean age of 54.3 years. Thirteen patients had femoral shaft fractures (according to the AO/OTA classification: 32-A, n = 2; 32-B, n = 6; 32-C, n = 5), whereas 38 patients had distal femoral fractures (33-A, n = 7; 33-C, n = 31). Coronal and sagittal alignments were assessed using simple radiography, whereas rotational alignment was assessed using CT. According to the difference between the affected and unaffected sides, we divided the patients into satisfactory and unsatisfactory groups (reference point of 8°, using Handolin's classification). Thereafter, we determined which factors can lead to malalignment, including fracture location (distal femoral shaft fracture or metaphyseal fracture), fracture pattern (simple fracture, n = 15; complex fractures, n = 36 patients), coronal and sagittal alignments, and combined ipsilateral long bone fractures. Results Coronal and sagittal alignment were satisfactory in 96.2% (average, 2.8°) and 98% (average, 2.2°), respectively, whereas the rotational alignment was satisfactory in 56.9% of patients. Leg length discrepancy was satisfactory in 92.3% of the patients (average, 10.9 mm). Concerning rotational malalignment, an unsatisfactory result was obtained in 48.6% of subjects with complex fractures and 26.7% of subjects with simple fractures (p = 0.114). No significant correlation was noted between the angular deformity in the coronal and sagittal planes and the degree of rotational alignment (p = 0.607 and 0.774, respectively). Conclusions Regardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after MIPO for fractures of the distal femur.

AB - Introduction Although minimally invasive plate osteosynthesis (MIPO) is a preferred operative treatment for fractures of the distal femur, malalignment is a significant concern because of indirect reduction of the fracture. The purpose of this study, therefore, was to evaluate radiologic alignment after MIPO for distal femoral fractures. Patients and methods Of the 138 patients with fracture of the distal femur who underwent MIPO, we enrolled 51 patients in whom bilateral rotational alignment could be assessed by postoperative computed tomography (CT). The patients included 32 men and 19 women, with a mean age of 54.3 years. Thirteen patients had femoral shaft fractures (according to the AO/OTA classification: 32-A, n = 2; 32-B, n = 6; 32-C, n = 5), whereas 38 patients had distal femoral fractures (33-A, n = 7; 33-C, n = 31). Coronal and sagittal alignments were assessed using simple radiography, whereas rotational alignment was assessed using CT. According to the difference between the affected and unaffected sides, we divided the patients into satisfactory and unsatisfactory groups (reference point of 8°, using Handolin's classification). Thereafter, we determined which factors can lead to malalignment, including fracture location (distal femoral shaft fracture or metaphyseal fracture), fracture pattern (simple fracture, n = 15; complex fractures, n = 36 patients), coronal and sagittal alignments, and combined ipsilateral long bone fractures. Results Coronal and sagittal alignment were satisfactory in 96.2% (average, 2.8°) and 98% (average, 2.2°), respectively, whereas the rotational alignment was satisfactory in 56.9% of patients. Leg length discrepancy was satisfactory in 92.3% of the patients (average, 10.9 mm). Concerning rotational malalignment, an unsatisfactory result was obtained in 48.6% of subjects with complex fractures and 26.7% of subjects with simple fractures (p = 0.114). No significant correlation was noted between the angular deformity in the coronal and sagittal planes and the degree of rotational alignment (p = 0.607 and 0.774, respectively). Conclusions Regardless of the fracture pattern, rotational malalignment may occur at an extremely high rate after MIPO for fractures of the distal femur.

KW - Distal femoral fracture

KW - Minimally invasive plate osteosynthesis

KW - Rotational malalignment

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