O High-energy distal femur fractures - a retrospective review of its complication rate and risk factor

Abstract

Objectives: To determine the incidence and risk factors of complications in high-energy distal femur fractures fixed with lateral locking plate. Design: Retrospective review Setting: Level I trauma center Patients and methods: Forty-seven patients were included, with 87.2% men and an average age of 38.9 years. The main radiographic parameters collected were the lateral distal femoral angle (LDFA), posterior distal femoral angle (PDFA), length of comminution, length of the plate, screw working length, bone loss, medial contact after reduction and plate-bone contact, location of the callus formation, and implant failure. The complications recorded were nonunion, implant failure, and infection. Results: Complex C2 and C3 fractures accounted for 85.1% cases. Open fractures accounted for 63.8% cases. The mean LDFA and PDFA were 79.8  4.0 and 79.3 6.0, respectively. The average total, proximal and distal working lengths were 133.3  42.7, 60.4  33.4, and 29.5  21.8 mm, respectively. The infection rate was 29.8%, and the only risk factor was open fracture (p=0.005). The nonunion rate was 19.1%, with a 2 longer working length (p=0.035) and higher PDFA (p=0.001) as risk factors. The location of callus formation also had influence in the nonunion (p=0.034). Conclusions: High-energy distal femur fractures have a higher incidence of nonunion and infection. Nonunion has as risk factors a longer working length, higher PDFA, and no callus formation on the medial and posterior sides. The risk factor for infection was open fracture.