Efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis in the treatment of distal femoral fractures in the elderly
Objective To compare the efficacy of double reverse traction reduction combined with minimally invasive percutaneous plate osteosynthesis(MIPO)and traditional reduction combined with MIPO in treating distal femoral fractures in the elderly.Methods A retrospective cohort study was conducted to analyze the clinical data of 78 elderly patients with distal femoral fractures admitted to Third Hospital of Hebei Medical University from January 2021 to June 2023,including 16 males and 62 females,aged 60-85 years[(74.5±7.1)years].The bone mineral density T-score was(-2.1±0.9)SD.According to the Orthopedic Trauma Association(OTA)classification,the fractures were classified as type 33-A1 in 27 patients,type 33-A2 in 36,and type 33-A3 in 15.Forty-three patients underwent traditional reduction combined with MIPO(traditional reduction group),while 35 patients received double reverse traction reduction combined with MIPO(double reverse traction group).The two groups were compared in terms of operation time,intraoperative blood loss,number of intraoperative fluoroscopies,time to initial callus formation,radiographic healing time,range of motion of knee flexion and extension and Knee Society score(KSS)at 1 and 3 months postoperatively and at the last follow-up,and the incidence of postoperative complications.Results All the patients were followed up for 6-18 months[(14.4±2.6)months].The operation time,intraoperative blood loss and number of intraoperative fluoroscopies were(73.7±7.6)minutes,(112.4±32.3)ml,and(9.8±4.5)times in the double reverse traction group,which were significantly reduced compared with those in the traditional reduction group[(95.2±10.0)minutes,(139.7±49.5)ml,(15.2±3.9)times]in the traditional reduction group(P＜0.01).There was no significant difference in the time to initial callus formation between the two groups(P＞0.05).The radiographic healing time in the double reverse traction group was(25.9±5.1)weeks,shorter than(29.6±8.2)weeks in the traditional reduction group(P＜0.05).At 1 month postoperatively,range of motion of knee flexion and extension in the double reverse traction group was(96.4±5.0)°,greater than(93.9±3.7)°in the traditional reduction group(P＜0.05),and there was no significant difference between the two groups at 3 months postoperatively or at the last follow-up(P＞0.05).KSS scores at 1 and 3 months postoperatively and at the last follow-up showed no significant difference between the two groups(P＞0.05).No malunions occurred in the double reverse traction group,while 9.3％(4/43)in the traditional reduction group had malunion(P＞0.05).No nonunion or infection was observed in either group.Conclusion Compared with traditional reduction combined with MIPO,double reverse traction reduction combined with MIPO for elderly distal femoral fractures can shorten operation time,reduce intraoperative blood loss and the number of fluoroscopies,promote fracture healing,and facilitate early recovery of knee joint function.
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