ABSTRACT
Significant work has been done in recent years on treatment strategies for distal femur fractures. Inclusive reviews on periprosthetic fractures of distal femur have been carried out recently, but there is a lack of such reviews on the subject of native distal femur fractures in the recent literature. In this narrative review, we are set out to address the latest updates on geriatric non-periprosthetic distal femur fractures, and perform a rapid review over different treatment options, arriving at a summarized proposed treatment algorithm.
Subject(s)
Femoral Fractures , Periprosthetic Fractures , Aged , Bone Plates , Femoral Fractures/surgery , Femur , Fracture Fixation, Internal , Humans , Periprosthetic Fractures/surgeryABSTRACT
With the increasing number of total knee arthroplasties (TKAs) being performed, the incidence of periprosthetic fractures adjacent to a TKA is rising. Minimally invasive plate osteosynthesis (MIPO) has proven to be successful for the biological fixation of many fractures. Advances in surgical instrumentation and techniques made MIPO possible for more complex fractures. Periprosthetic fractures are always complicated by problems of soft tissue incisions, scarring, and, of course, the arthroplasty components. MIPO techniques may be particularly suited to these injuries and may make the surgical repair of these fractures safer and more reliable. In this review, case examples are used to define the indications, preoperative planning, implant selection, complications, limitations, and challenges of MIPO for the treatment of periprosthetic fractures about the knee. When considering MIPO for any fracture, we recommend prioritizing an acceptable reduction with biological fixation and resorting to mini-open or open approach when necessary to achieve it. Awareness of the learning curve of the surgical technique, advances in implant designs, the tips and tricks involved, and the limitations of the MIPO is of paramount importance from the orthopaedic surgeon's perspective.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation, Internal/methods , Periprosthetic Fractures/surgery , Aged, 80 and over , Arthroplasty, Replacement, Knee/adverse effects , Bone Plates , Female , Femoral Fractures/diagnostic imaging , Femoral Fractures/etiology , Fracture Fixation, Internal/instrumentation , Humans , Knee Prosthesis/adverse effects , Learning Curve , Minimally Invasive Surgical Procedures/methods , Orthopedic Surgeons , Periprosthetic Fractures/diagnostic imaging , Periprosthetic Fractures/etiology , Radiography , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of this study is to evaluate mortality and survival rates of patients aged 65 years or older who sustained a hip fracture and were treated at a hospital in Bogotá, Colombia, after the establishment of an Orthogeriatric Program. METHOD: In total, 298 patients were treated according to the program's protocol. The primary outcome was 1-year mortality. Mortality predictors were estimated using Cox proportional hazards model, and survival was measured with Kaplan-Meier analysis. RESULTS: The annual survival rate increased from 80% to 89% ( p = .039) 4 years after its implementation. There was a significant decrease in mortality risk (Hazard Ratio = 0.54, p = .049). Arrhythmia, valvular heart disease, history of myocardial infarction, and age greater than 85 years were predictors of mortality. DISCUSSION: This is the first study in Latin America to show decreased mortality rates 1 year after the implementation of an Orthogeriatric Program. Our rates were lower than developed countries, suggesting the existence of additional factors that influence long-term outcomes.
