Skip to main content

Advertisement

SpringerLink
Log in

Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time?

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Achieving adequate reduction is difficult when performing minimally invasive plate osteosynthesis (MIPO) in elderly patients with simple distal femur fracture. This study aimed to evaluate the elderly patients who had undergone percutaneous wiring-assisted reduction with MIPO for simple distal femur fractures to determine the effect of this technique on reduction quality and fracture union.

Materials and methods

Between January 2009 and September 2017, 56 patients (56 femurs) with displaced simple distal femur fractures treated with MIPO at three trauma centers were finally enrolled. The MIPO technique with percutaneous cerclage wire reduction was performed in 25 patients (Group A). Among them, 12 patients had a simple spiral metaphyseal fracture (Group A*). In comparison, MIPO without percutaneous cerclage wire reduction was performed in 31 patients (Group B). Among them, seven patients had a simple spiral metaphyseal fracture (Group B*). Medical records containing surgical records were retrospectively reviewed to investigate demographic data, comorbidities, complications, operative time, and fluoroscopic time. Radiographs were evaluated for assessing the quality of the reduction and fracture union.

Results

The mean fracture union time of Group A* was 21.7 weeks, which was significantly shorter than that of Group B* (28.6 weeks). The mean coronal and sagittal angulation in Group A* was 0.6° and 0.7°, respectively, which were significantly lesser than those in Group B* (2.4° and 3.2°, respectively). Mean translation in Group A* was 1.43 mm, which was significantly shorter than that in Group B* (3.81 mm). Nonunion occurred in two patients in Group B.

Conclusion

Surgical treatment of simple spiral distal femur fractures with percutaneous cerclage wiring-assisted reduction and the MIPO technique in elderly patients resulted in better reduction and faster union time. Therefore, this technique could be a good solution if used in accordance with the indication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT, Appleton PT, Zurakowski D, Vrahas MS (2014) Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case–control study of 283 fractures. Injury 45(3):554–559

    Article  Google Scholar 

  2. Salminen S, Pihlajamaki H, Avikainen V, Kyro A, Bostman O (1997) Specific features associated with femoral shaft fractures caused by low-energy trauma. J Trauma 43(1):117–122. https://doi.org/10.1097/00005373-199707000-00027

    Article  CAS  PubMed  Google Scholar 

  3. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL (2011) Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 25(Suppl 1):S8–S14. https://doi.org/10.1097/BOT.0b013e3182070127

    Article  PubMed  Google Scholar 

  4. Collinge CA, Gardner MJ, Crist BD (2011) Pitfalls in the application of distal femur plates for fractures. J Orthop Trauma 25(11):695–706. https://doi.org/10.1097/BOT.0b013e31821d7a56

    Article  PubMed  Google Scholar 

  5. Barei DP, Beingessner DM (2012) Open distal femur fractures treated with lateral locked implants: union, secondary bone grafting, and predictive parameters. Orthopedics 35(6):e843–e846

    Article  Google Scholar 

  6. Park J, Lee JH (2016) Comparison of retrograde nailing and minimally invasive plating for treatment of periprosthetic supracondylar femur fractures (OTA 33-A) above total knee arthroplasty. Arch Orthop Trauma Surg 136(3):331–338. https://doi.org/10.1007/s00402-015-2374-8

    Article  PubMed  Google Scholar 

  7. Ricci WM, Bellabarba C, Lewis R, Evanoff B, Herscovici D, Dipasquale T, Sanders R (2001) Angular malalignment after intramedullary nailing of femoral shaft fractures. J Orthop Trauma 15(2):90–95

    Article  CAS  Google Scholar 

  8. Kolb W, Guhlmann H, Windisch C, Marx F, Kolb K, Koller H (2008) Fixation of distal femoral fractures with the Less Invasive Stabilization System: a minimally invasive treatment with locked fixed-angle screws. J Trauma Acute Care Surg 65(6):1425–1434

    Article  Google Scholar 

  9. Weight M, Collinge C (2004) Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma 18(8):503–508

    Article  Google Scholar 

  10. Kregor PJ, Stannard JA, Zlowodzki M, Cole PA (2004) Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures. J Orthop Trauma 18(8):509–520

    Article  Google Scholar 

  11. Apivatthakakul T, Phornphutkul C, Bunmaprasert T, Sananpanich K, Dell’Oca AF (2012) Percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO): a percutaneous reduction technique in the treatment of Vancouver type B1 periprosthetic femoral shaft fractures. Arch Orthop Trauma Surg 132(6):813–822

    Article  Google Scholar 

  12. Xue H, Tu Y, Cai M, Yang A (2011) Locking compression plate and cerclage band for type B1 periprosthetic femoral fractures: preliminary results at average 30-month follow-up. J Arthroplast 26(3):467–471

    Article  Google Scholar 

  13. Apivatthakakul T, Siripipattanamongkol P, Oh CW, Sananpanich K, Phornphutkul C (2018) Safe zones and a technical guide for cerclage wiring of the femur: a computed topographic angiogram (CTA) study. Arch Orthop Trauma Surg 138(1):43–50. https://doi.org/10.1007/s00402-017-2804-x

    Article  PubMed  Google Scholar 

  14. Ehlinger M, Adam P, Abane L, Arlettaz Y, Bonnomet F (2011) Minimally-invasive internal fixation of extra-articular distal femur fractures using a locking plate: tricks of the trade. Orthop Traumatol Surg Res 97(2):201–205. https://doi.org/10.1016/j.otsr.2010.11.004

    Article  CAS  PubMed  Google Scholar 

  15. Binkley JM, Stratford PW, Lott SA, Riddle DL (1999) The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network. Phys Ther 79(4):371–383

    CAS  PubMed  Google Scholar 

  16. Pietu G, Ehlinger M (2017) Minimally invasive internal fixation of distal femur fractures. Orthop Traumatol Surg Res 103(1S):S161–S169. https://doi.org/10.1016/j.otsr.2016.06.025

    Article  CAS  PubMed  Google Scholar 

  17. Kim JW, Oh CW, Oh JK, Park KH, Kim HJ, Kim TS, Seo I, Park EK (2018) Treatment of infra-isthmal femoral fracture with an intramedullary nail: is retrograde nailing a better option than antegrade nailing? Arch Orthop Trauma Surg 138(9):1241–1247. https://doi.org/10.1007/s00402-018-2961-6

    Article  PubMed  Google Scholar 

  18. Peschiera V, Staletti L, Cavanna M, Saporito M, Berlusconi M (2018) Predicting the failure in distal femur fractures. Injury 49(Suppl 3):S2–S7. https://doi.org/10.1016/j.injury.2018.10.001

    Article  PubMed  Google Scholar 

  19. Perren SM (2002) Evolution of the internal fixation of long bone fractures: the scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Jt Surg Br 84(8):1093–1110

    Article  Google Scholar 

  20. Wang SH, Wu CC, Li WT, Shen HC, Lin LC, Pan RY (2019) Outcomes of distal femoral fractures treated with minimally invasive plate osteosynthesis versus open reduction internal fixation with combined locking plate and interfragmentary screws. Int J Surg 65:107–112. https://doi.org/10.1016/j.ijsu.2019.03.019

    Article  PubMed  Google Scholar 

  21. Angelini A, Battiato C (2016) Combination of low-contact cerclage wiring and osteosynthesis in the treatment of femoral fractures. Eur J Orthop Surg Traumatol 26(4):397–406. https://doi.org/10.1007/s00590-016-1761-3

    Article  PubMed  Google Scholar 

  22. Lenz M, Perren SM, Gueorguiev B, Richards RG, Krause F, dell'Oca AF, Hontzsch D, Windolf M (2012) Underneath the cerclage: an ex vivo study on the cerclage-bone interface mechanics. Arch Orthop Trauma Surg 132(10):1467–1472. https://doi.org/10.1007/s00402-012-1572-x

    Article  PubMed  Google Scholar 

  23. Perren SM, Fernandez Dell'Oca A, Lenz M, Windolf M (2011) Cerclage, evolution and potential of a Cinderella technology. An overview with reference to periprosthetic fractures. Acta Chir Orthop Traumatol Cech 78(3):190–199

    CAS  PubMed  Google Scholar 

  24. Shukla S, Johnston P, Ahmad MA, Wynn-Jones H, Patel AD, Walton NP (2007) Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails. Injury 38(11):1286–1293. https://doi.org/10.1016/j.injury.2007.05.013

    Article  PubMed  Google Scholar 

  25. Kim JW, Park KC, Oh JK, Oh CW, Yoon YC, Chang HW (2014) Percutaneous cerclage wiring followed by intramedullary nailing for subtrochanteric femoral fractures: a technical note with clinical results. Arch Orthop Trauma Surg 134(9):1227–1235. https://doi.org/10.1007/s00402-014-2023-7

    Article  PubMed  Google Scholar 

  26. Apivatthakakul T, Phornphutkul C, Bunmaprasert T, Sananpanich K, Fernandez Dell'Oca A (2012) Percutaneous cerclage wiring and minimally invasive plate osteosynthesis (MIPO): a percutaneous reduction technique in the treatment of Vancouver type B1 periprosthetic femoral shaft fractures. Arch Orthop Trauma Surg 132(6):813–822. https://doi.org/10.1007/s00402-012-1489-4

    Article  PubMed  Google Scholar 

  27. Grob K, Manestar M, Lang A, Ackland T, Gilbey H, Kuster MS (2015) Effects of ligation of lateral intermuscular septum perforating vessels on blood supply to the femur. Injury 46(12):2461–2467. https://doi.org/10.1016/j.injury.2015.09.029

    Article  CAS  PubMed  Google Scholar 

  28. Aleto T, Ritter MA, Berend ME (2008) Case report: superficial femoral artery injury resulting from cerclage wiring during revision THA. Clin Orthop Relat Res 466(3):749–753. https://doi.org/10.1007/s11999-007-0109-z

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kelly BA, Hambright DS, Rodriguez EK (2017) Risk of injury to neurovascular structures during open cerclage wiring of the femur: a cadaveric study. J Surg Orthop Adv 26(1):1–6

    Article  Google Scholar 

  30. Ehlinger M, Niglis L, Favreau H, Kuntz S, Bierry G, Adam P, Bonnomet F (2018) Vascular complication after percutaneous femoral cerclage wire. Orthop Traumatol Surg Res 104(3):377–381. https://doi.org/10.1016/j.otsr.2017.10.020

    Article  CAS  PubMed  Google Scholar 

  31. Kim JW, Oh CW, Oh JK, Park IH, Kyung HS, Park KH, Yoon SD, Kim SM (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

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The submitted manuscript does not contain information about medical device(s)/drug(s). No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. We would like to thank Editage (https://www.editage.co.kr) for English language editing.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Gyeonggi-do, South Korea

    Jae-Ho Lee & Ki-Chul Park

  2. Department of Orthopedic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea

    Seung-Jae Lim & Kyeu-Back Kwon

  3. Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, South Korea

    Ji Wan Kim

Authors
  1. Jae-Ho Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ki-Chul Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Seung-Jae Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kyeu-Back Kwon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji Wan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ki-Chul Park.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, JH., Park, KC., Lim, SJ. et al. Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time?. Arch Orthop Trauma Surg 140, 1403–1412 (2020). https://doi.org/10.1007/s00402-020-03385-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03385-8

Keywords

Search

Navigation