Single-Implant Versus Dual-Implant Fixation of Distal Femur Extra-articular and Complete Articular Fractures
Abstract
Fractures of the distal femur are severe and common injuries sustained by Wounded Warriors in combat. Despite advances in implant technology, these injuries continue to have an unacceptably high rate of nonunion (failure to heal) of approximately 20%. This adverse outcome requires additional surgery to achieve fracture healing, which prolongs recovery and further delays return to duty often beyond 1 year after injury. Despite numerous studies of a variety of different surgical treatment strategies, the incidence of nonunion remains high. Therefore, any novel strategy to reduce the risk of nonunion and accelerate return to activities after distal femur fracture warrants rigorous study. The goal of this study is to investigate a potential treatment for distal femur fractures that has the potential to improve likelihood of fracture healing and accelerate return of patient function during the healing process. Usually, these injuries are treated with either (1) a large metallic plate anchored to the side of the femur with screws or (2) a rod placed into the intramedullary canal of the femur (through the center of the bone). Either of these implants can maintain alignment of the femur while it heals but may not provide sufficient stability of the fracture to optimize patient comfort during activity. Another treatment option is dual implant fixation in which both implants are used simultaneously, or plates and screws are plated both medially and laterally. Recent case series using dual implant fixation have shown much lower nonunion rates than have been found in clinical outcomes studies with single implant fixation. Patients in these series were also allowed to weight bear as tolerated immediately following surgery in contrast to most patients with single implants who are instructed to limit weight bearing for 6-12 weeks. These reports do not include control subjects or enough patients to effectively guide clinical practice. This study will compare return to activity and work at one-year post-injury among patients treated with a single implant and those treated with dual implants. The proposed study addresses the FY22 PRORP Clinical Trial Award Focus Area of Retention Strategies, specifically return to duty. The study will include patients with high-energy distal femur fractures to best approximate the types of injuries seen by military personnel. By accelerating postoperative recovery, improving patient comfort with activity through increased fracture stability, and optimizing the likelihood of return to work and activities, we can avoid reoperations and associated complications as well as prolonged convalescence and delayed functional recovery. Dual implant fixation offers the possibility of significantly increasing likelihood of return to duty after distal femur fracture by combining two common treatment strategies that can be performed anywhere in the military that is equipped for definitive fracture care.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252311075
Entities
People
- Laurence B. Kempton
Organizations
- United States Army
- Wake Forest University