Aim To demonstrate validity of a bio-metallic solution in bone healing combined with the quadriceps safe approach in the treatment of nonunions of distal femur while malunions were treated by metallic solution. Methods We treated 57 patients with nonunion or malunion of distal femur at the Orthopaedics and Traumatology Department of a single orthopaedic trauma centre (Italy). A total of 57 patients were divided in two groups: the first (NU) group was composed of 35 patients affected; the second group (MU) was composed of 22 patients affected by malunion of distal femur. Criteria chosen to evaluate the two groups during a clinical and radiological followup were: the quality of life measured by the Short Form (12) Health Survey, the knee function and quality of life related to it measured by the Knee Injury and Osteoarthritis Outcome Score KOOS and the Knee Society Score, bone healing measured by modified Radiographic Union Score by X-rays during the follow-up and CT at one year after the surgery, the difference of the limbs length before and after the revision surgery, and postoperative complications. The evaluation endpoint was set at 12 months. Results There were no statistical differences between the two groups. Conclusion The role of bio-metallic solution in the treatment of nonunions and malunions is to recreate the knee anatomy and functionality compatible with a satisfactory quality of life.
Zlowodzki M, Bhandari M, Marek D, Cole P, Kregor P. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series. J Orthop Trauma. 1989. p. 366–71.
2.
Chan D, Jeffcoat D, Lorich D, Helfet D. Nonunions around the knee joint. Int Orthop. 2010. p. 271–81.
3.
Gangavalli A, Nwachuku C. Management of distal femur fractures in adults: an overview of options. Orthop Clin North Am. 2016. p. 85–96.
4.
Agrawal A, Kiyawat V. Complex AO type C3 distal femur fractures: results after fixation with a lateral locked plate using modified swashbuckler approach. Indian J Orthop. 2017. p. 18–27.
5.
Wu C. A novel approach for evaluating acceptable intra-operative correction of lower limb alignment in femoral and tibial malunion using the deviation angle of the normal contralateral knee. Knee. 2014. p. 573–81.
6.
Fracture and dislocation compendium. Orthopaedic Trauma Association Committee for Coding and Classification. J Orthop Trauma. 1996. p. 1–154.
7.
Lizaur-Utrilla A, Miralles-Muñoz F, Sanz-Reig J. Functional outcome of total knee arthroplasty after periprosthetic distal femoral fracture. J Arthroplasty. 2013. p. 1585–8.
8.
Kessler S, Lang S, Puhl W, Stöve J. The Knee Injury and Osteoarthritis Outcome Score--a multifunctional questionnaire to measure outcome in knee arthroplasty. Z Orthop Ihre Grenzgeb. 2003. p. 277–82.
9.
Litrenta J, Tornetta P 3rd, Mehta S, Jones C, Oʼtoole R, Bhandari M, et al. Determination of radiographic healing: an assessment of consistency using RUST and modified RUST in metadiaphyseal fractures. J Orthop Trauma. 2015. p. 516–20.
10.
Paley D. Principles of Deformity Correction. Springer; 2003. p. 1–18.
11.
Calori G, Colombo M, Mazza E, Mazzola S, Malagoli E, Marelli N, et al. Validation of the Non-Union Scoring System in 300 long bone nonunions. Injury. 2014. p. 93–7.
12.
Fakler J, Hepp P, Marquaß B. von Dercks N, Josten C. Is distal femoral replacement an adequate therapeutic option after complex fractures of the distal femur? Z Orthop Unfall. 2013. p. 173–9.
13.
Pakuła G, Kwiatkowski K, Kuczmera P, Fudalej P. Assessment of outcomes of treatment of fractures of distal femur with a locking plate taking into account factors influencing the result. Ortop Traumatol Rehabil. 2015. p. 501–11.
14.
Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013. p. 353–60.
15.
Bertrand M, Andrés-Cano P, Fj PL. Periarticular fractures of the knee in polytrauma patients. Open Orthop J. 2015. p. 332–46.
16.
Link B, Babst R. Current concepts in fractures of the distal femur. Acta Chir Orthop Traumatol Cech. 2012. p. 11–20.
17.
Holschen M, Lobenhoffer P. Treatment of extension contracture of the knee by quadriceps plasty (Judet procedure). Oper Orthop Traumatol. 2014. p. 353–60.
18.
Mahran M, Batrawy E, Sala Y, F, Kersh A, M. Quadricepsplasty: a sustained functional achievement in front of a deteriorated flexion gain. Injury. 2014. p. 1643–7.
19.
Liu S, Cui Z, Han X, Liu K, Wang A. The therapeutic effect analysis of three kinds of methods for the management of post traumatic knee stiffness. Zhonghua Wai Ke Za Zhi. 2012. p. 84–7.
20.
Oliveira V, Elia D, Tirico L, Gobbi L, Pecora R, Camanho J, et al. Judet quadricepsplasty in the treatment of posttraumatic knee rigidity: long-term outcomes of 45 cases. J Trauma Acute Care Surg. 2012. p. 77–80.
21.
Ebrahimzadeh M, Birjandi-Nejad A, Ghorbani S, Khorasani M. A modified Thompson quadricepsplasty for extension contracture resulting from femoral and periarticular knee fractures. J Trauma. 2010. p. 1471–5.
22.
Van Der Woude J, Spruijt S, Van Ginneken B, Van Heerwaarden R. Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique. Strategies Trauma Limb Reconstr. 2016. p. 177–86.
23.
Carta S, Fortina M, Riva A, Meccariello L, Manzi M, Giovanni D, et al. The biological metallic versus metallic solution in treating periprosthetic femoral fractures: outcome assessment. Adv Med. 2016. p. 2918735.
24.
Peters C, Bachus K, Davitt J. Fixation of periprosthetic femur fractures: a biomechanical analysis comparing cortical strut allograft plates and conventional metal plates. Orthopedics. 2003. p. 695–9.
25.
Batista B, Volpon J, Shimano A, Kfuri M. Varization open-wedge osteotomy of the distal femur: comparison between locking plate and angle blade plate constructs. Knee Surg Sports Traumatol Arthrosc. 2015. p. 2202–7.
26.
Andrade P, Rodrigues M, Mendonça A, C, Portela S, L. Fixation of supracondylar femoral fractures: a biomechanical analysis comparing 95° blade plates and dynamic condylar screws (dcs). Rev Bras Ortop. 2015. p. 84–8.
27.
Buck B, Murtha Y. The management of bone defects in periarticular knee injuries: a review article. J Knee Surg. 2017. p. 194–9.
28.
Barak M, Lieberman D, Hublin J. A Wolff in sheep’s clothing: trabecular bone adaptation in response to changes in joint loading orientation. Bone. 2011. p. 1141–51.
29.
Calori G, Giannoudis P. Enhancement of fracture healing with the diamond concept: the role of the biological chamber. Injury. 2011. p. 1191–3.
30.
Rollo G, Tartaglia N, Falzarano G, Pichierri P, Stasi A, Medici A, et al. The challenge of nonunion in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut. Eur J Trauma Emerg Surg. 2017. p. 853–61.
31.
Schep N, Van Lieshout E, Patka P, Vogels L. Long-term functional and quality of live assessment following post-traumatic distraction osteogenesis of the lower limb. Strategies Trauma Limb Reconstr. 2009. p. 107–12.
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