Peri-implant and subsequent proximal femur fractures above distally based supracondylar femoral fixation constructs
Year: 2025
Type: article
Study design: Observational Study
Abstract: Objectives: To determine rates of peri-implant and subsequent proximal femur fractures in distally based constructs used to treat supracondylar distal femur fractures. Design: Retrospective cohort study. Setting: Level I Trauma Center, Midwestern United States. Patients/participants: The institutional electronic medical record was used to identify patients with displaced supracondylar femur fractures that were surgically treated with distally based fixation. Exclusion criteria included less than 6 months of follow-up, antegrade fixation, preexisting implants in the proximal femur, and instances where arthroplasty was performed as the initial treatment. Intervention: Distal femoral plate and/or retrograde intramedullary nail. Main outcome measurements: Rates of peri-implant and subsequent proximal fractures above distally based fixation of supracondylar femur fractures; any additional complications related to prophylactic proximal femoral fixation. Results: Ninety-four patients were identified who had supracondylar femur fractures treated with distally based constructs; 65 were treated with plating, 25 with retrograde nails, and 4 with a nail-plate combination. After the index distal femoral fracture fixation, 3 patients (3.2%) sustained peri-implant fractures and 5 others (5.3%) had proximal femoral fractures, so that the combined fracture rate adjacent to or above the distally based implants was 8.5%. Prophylactic fixation of the proximal femur above the retrograde implant was performed in 10 patients. Excluding these 10 patients, the subsequent combined peri-implant/proximal femoral fracture rate was 9.5% (8/84). This rate rose to 14.5% in patients over age 60 without prophylactic fixation. There were no complications including subsequent fracture associated with prophylactic fixation of the proximal femur. Conclusions: In patients over 60 years of age, the combined incidence of peri-implant and subsequent proximal fracture associated with distally based fixation of supracondylar femur fractures was 14.5% in this series. There were no associated complications with prophylactic fixation. Level of evidence: Level III.
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,900
OpenAlex ID: W4415615978