Cable Augmentation for Distal Periprosthetic Femur Fractures
Introduction: Distal periprosthetic femur fractures (PFF) are increasing in incidence and have a high degree of morbidity and mortality, similar to that of the hip fracture population. The current primary operative approach for distal PFFs is plate and screw fixation. We aim to examine the outcomes of augmenting these plate and screw constructs with cable fixation. We hypothesize that cable augmentation (CA) provides improved post-operative outcomes compared to non-cable augmentation (NCA) for distal PFFs.
Methods: We retrospectively analyzed patients ≥ 65 years old who underwent operative repair of a distal periprosthetic femur fracture, comparing patients who had cable augmentation to those without cable augmentation. The primary outcome was change in ambulatory status, defined as a change in baseline ambulatory level of independence (LOI) . LOIs were classified as ambulatory, assisted, and non-ambulatory. Secondary outcomes included length of stay (LOS), operative complications, and revisions. Data were analyzed using the t test, chi-square or Fisher’s exact tests where appropriate. A p-value of ≤0.05 indicated statistical significance.
Results: A total of 40 patients were included, of which 13 (33%) had cable augmentation. In the cable augmented group, a lower proportion of patients exhibited a decline in level of independence [5 (38.5%) CA vs 19 (70.4%) NCA, p=0.09]. There were no operative revisions in the CA group, compared to 3 (11.5%) in the NCA group (p=0.5). There were no significant differences between the two groups in terms of LOS [7.5 ・} 3.9 CA vs 6.1 ・} 3.1 NCA, p=0.2] and complications [2 (15.4%) CA vs 1 (3.7%) NCA, p=0.2].
Conclusions: The presented data reveals that when cable augmented constructs were used for fixation of distal PFFs, a lower proportion of patients exhibited a decline in baseline ambulatory status. While this study is lacking power for statistical significance, the data does show a trend toward favorable outcomes with cable augmented constructs. This is logical given the stronger overall support provided by cables. Continued investigations should be considered to further examine cable augmentation for distal periprosthetic femur fractures.
Michels, R., Ramos, J., Dandu, N., Muller, A., & Ong, A. (2020). Cable Augmentation for Distal Periprosthetic Femur Fractures. Retrieved from https://scholarcommons.towerhealth.org/trauma_serv_read/29