Novel classification system for periprosthetic distal femoral fractures: a consideration for comminution.
Eur J Orthop Surg Traumatol
; 33(6): 2541-2546, 2023 Aug.
Article
em En
| MEDLINE
| ID: mdl-36635567
ABSTRACT
PURPOSE:
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.METHODS:
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).RESULTS:
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).CONCLUSION:
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. LEVEL OF EVIDENCE Retrospective comparative study, Level IV.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Fraturas Cominutivas
/
Fraturas Periprotéticas
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Fraturas do Fêmur
/
Fraturas Femorais Distais
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
Eur J Orthop Surg Traumatol
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Estados Unidos