MODERN TREATMENT OF POST-TRAUMATIC EXTRA-ARTICULAR DEFORMITY OF THE FEMUR

Authors

DOI:

https://doi.org/10.15674/0030-59872023167-79

Keywords:

Post-traumatic extra-articular deformity, femur, surgical treatment, 3D-modeling, 3D-printing

Abstract

The issue of adequate treatment of post-traumatic deformities of long bones has become more urgent due to the large number of injured as a result of combat trauma and the presence of residual displacement of fragments after primary care providing. Objective. On the basis of literature analysis and own clinical experience, present methods of treatment of post-traumatic extra-articular deformity of the distal part of the femur (DF). Methods. The available professional literature, publications in electronic systems Google Scholar, PubMed, ScienceDirect were analyzed. The results of treatment of 38 patients with post-traumatic extra-articular deformities of the DF, in which the fracture line was extended to the area of the joint at the time of the primary injury, were studied. To plan the surgical treatment, the author's 3D-printing technology was used in 12 patients with the most complex cases. A clinical example
is given. Results. Key moments of patient examination, principles of correction and approaches to its planning in case of DF multiplanar deformities are defined. The results of 3D-visualization and 3D-printing of the damaged segment during the examination and planning of deformity correction were evaluated. All patients to whom the 3D-modeling technique was applied were operated оn, considering the individual characteristics of the deformity.
After each stage of surgical treatment, a course of individual rehabilitation treatment was carried out. Positive dynamics of functional results were obtained within 12 months according to SF-36 and AOFAS scales. Conclusions. The use of 3D-modeling during the planning of corrective surgery allows the surgeon to increase the accuracy of the correction and significantly reduce the time of the operation. Well-known and improved methods with individually selected rehabilitation, used for the treatment of post-traumatic extra-articular deformities of the distal femur contribute to faster recovery, avoiding potential complications and achieving positive functional outcome in such patients.

Author Biographies

Kostiantyn Romanenko, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, PhD in Traumatology and Orthopaedics

Yaroslav Doluda, Sytenko Institute of Spine and Joint Pathology National Academy of Medical Sciences of Ukraine, Kharkiv

MD, PhD in Traumatology and Orthopaedics

References

  1. Agarwal A. (2018). Distal femoral nonunions. In: Agarwal A. (ed). Nonunions. New York: Springer. https://doi.org/10.1007/978-1-4939-7178-7_11
  2. Gangavalli, A. K., & Nwachuku, C. O. (2016). Management of Distal Femur Fractures in Adults. Orthopedic Clinics of North America, 47(1), 85–96. https://doi.org/10.1016/j.ocl.2015.08.011
  3. S. B. Noreyko, I. P. Zenchenkov, R. P. Fedoryshin, M. V. Saveliev (2014). [Physical rehabilitation for femoral fractures]. Science and education (Ukraine), No. 4, 115–118. (in Ukrainian)
  4. Korzh, M., Gerasimenko, S., Klimovitskiy, V., Loskutov, O., Romanenko, K., Gerasimenko, A., & Kolomiets, O. (2010). Prevalence of bone fractures and results of their treatment in Ukraine (a clinical-epidemiological study). ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, (3), 5. https://doi.org/10.15674/0030-5987201035-14 (in russian)
  5. Naumenko, L., Pogrebnoy, O., & Vinnik, O. (2011). Age-specific peculiarities in fractures of the distal radial epimetaphysis. ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, (4), 13. https://doi.org/10.15674/0030-59872011413-16 (in russian)
  6. Arneson, T. J., Melton, L. J., Lewallen, D. G., & O’Fallon, W. M. (1988). Epidemiology of Diaphyseal and Distal Femoral Fractures in Rochester, Minnesota, 1965-1984. Clinical Orthopaedics and Related Research, &NA;(234), 188-194. https://doi.org/10.1097/00003086-198809000-00033
  7. Court-Brown, C. M., & Caesar, B. (2006). Epidemiology of adult fractures: A review. Injury, 37(8), 691–697. https://doi.org/10.1016/j.injury.2006.04.130
  8. Elsoe, R., Ceccotti, A. A., & Larsen, P. (2017). Population-based epidemiology and incidence of distal femur fractures. International Orthopaedics, 42(1), 191–196. https://doi.org/10.1007/s00264-017-3665-1
  9. Smith, J. R. A., Halliday, R., Aquilina, A. L., Morrison, R. J. M., Yip, G. C. K., McArthur, J., Hull, P., Gray, A., & Kelly, M. B. (2015). Distal femoral fractures. Injury, 46(6), 1084–1088. https://doi.org/10.1016/j.injury.2015.02.016
  10. Rollo, G., Pichierri, P., Grubor, P., Marsilio, A., Bisaccia, M., Grubor, M., Pace, V., Lanzetti, R. M., Giaracuni, M., Filipponi, M., Meccariello, L. (2019). The challenge of nonunion and malunion in distal femur surgical revision. Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina, 16 (2), 292–301. doi: 10.17392/1016-19
  11. Romanenko, K., Doluda, Y., Prozorovskiy, D., & Pariy, V. (2021). The clinical significance of posttraumatic malunions of lower extremities long bones. ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, (4), 72–79. https://doi.org/10.15674/0030-59872020472-79 (in Ukrainian)
  12. Jaarsma, R. L., Pakvis, D. F. M., Verdonschot, N., Biert, J., & van Kampen, A. (2004). Rotational Malalignment After Intramedullary Nailing of Femoral Fractures. Journal of Orthopaedic Trauma, 18(7), 403–409. https://doi.org/10.1097/00005131-200408000-00002
  13. Gordon, J. E., & Davis, L. E. (2019). Leg Length Discrepancy. Journal of Pediatric Orthopaedics, 39, S10—S13. https://doi.org/10.1097/bpo.0000000000001396
  14. Lill, M., Attal, R., Rudisch, A., Wick, M. C., Blauth, M., & Lutz, M. (2015). Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study. European Journal of Trauma and Emergency Surgery, 42(6), 733–740. https://doi.org/10.1007/s00068-015-0595-8
  15. Tetsworth, K., Prodger, S. (2007). Post-traumatic reconstrution: femoral malunion. In S. R. Rozbruch, S. Ilizarov. Limb lengthening and reconstruc¬tion surgery (pp. 177–184). New York : Informa.
  16. Romanenko, K., Prozorovskiy, D., & Doluda, Y. (2021). 3D-print in the planning of surgical treatment in the case of extraarticular deformity of lower limbs. ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, (2), 45–50. https://doi.org/10.15674/0030-59872021245-50 (in Ukrainian & English)
  17. Romanenko, K. (2020). Posttraumatic deformities of the bones, forming knee joint: general evaluation and treatment tactics. ORTHOPAEDICS, TRAUMATOLOGY and PROSTHETICS, (2), 92–98. https://doi.org/10.15674/0030-59872020292-98 (in Ukrainian)
  18. Kim, J.-W., Oh, C.-W., Oh, J.-K., Park, I.-H., Kyung, H.-S., Park, K.-H., Yoon, S.-D., & Kim, S.-M. (2017). Malalignment after minimally invasive plate osteosynthesis in distal femoral fractures. Injury, 48(3), 751–757. https://doi.org/10.1016/j.injury.2017.01.019
  19. Kohn, M. D., Sassoon, A. A., & Fernando, N. D. (2016). Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis. Clinical Orthopaedics and Related Research®, 474(8), 1886–1893. https://doi.org/10.1007/s11999-016-4732-4
  20. El Ghazaly, S. A., & El-Moatasem, E.-H. M. (2015). Femoral supracondylar focal dome osteotomy with plate fixation for acute correction of frontal plane knee deformity. Strategies in Trauma and Limb Reconstruction, 10(1), 41–47. https://doi.org/10.1007/s11751-015-0218-2
  21. He, Q., Wang, H., Sun, H., Zhan, Y., Zhang, B., Xie, X., & Luo, C. (2019). Medial Open‐wedge Osteotomy with Double‐plate Fixation for Varus Malunion of the Distal Femur. Orthopaedic Surgery, 11(1), 82–90. https://doi.org/10.1111/os.12421
  22. Meinberg, E., Agel, J., Roberts, C., Karam, M., & Kellam, J. (2018). Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma, 32, S1—S10. https://doi.org/10.1097/bot.0000000000001063
  23. Paley, D. (2002). Principles of Deformity Correction. Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-642-59373-4
  24. Zehntner, M. K., Marchesi, D. G., Burch, H., & Ganz, R. (1992). Alignment of Supracondylar/Intercondylar Fractures of the Femur After Internal Fixation by AO/ASIF Technique. Journal of Orthopaedic Trauma, 6(3), 318–326. https://doi.org/10.1097/00005131-199209000-00009
  25. Anneberg, M., & Brink, O. (2018). Malalignment in plate osteosynthesis. Injury, 49, S66—S71. https://doi.org/10.1016/s0020-1383(18)30307-3
  26. Braten, M., Terjesen, T., & Rossvoll, I. (1993). Torsional deformity after intramedullary nailing of femoral shaft fractures. Measurement of anteversion angles in 110 patients. The Journal of Bone and Joint Surgery. British volume, 75-B(5), 799–803. https://doi.org/10.1302/0301-620x.75b5.8376444
  27. Buckley, R., Mohanty, K., & Malish, D. (2011). Lower limb malrotation following MIPO technique of distal femoral and proximal tibial fractures. Injury, 42(2), 194–199. https://doi.org/10.1016/j.injury.2010.08.024
  28. Davison, B. L. (2003). Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. American journal of orthopedics (Belle Mead, N.J.), 32 (1), 27–30.
  29. Davis, J. T., & Rudloff, M. I. (2019). Posttraumatic Arthritis After Intra-Articular Distal Femur and Proximal Tibia Fractures. Orthopedic Clinics of North America, 50(4), 445–459. https://doi.org/10.1016/j.ocl.2019.06.002
  30. Rademakers, M. V., Kerkhoffs, G. M. M. J., Sierevelt, I. N., Raaymakers, E. L. F. B., & Marti, R. K. (2004). Intra-Articular Fractures of the Distal Femur. Journal of Orthopaedic Trauma, 18(4), 213–219. https://doi.org/10.1097/00005131-200404000-00004
  31. Schenker, M. L., Mauck, R. L., Ahn, J., & Mehta, S. (2014). Pathogenesis and Prevention of Posttraumatic Osteoarthritis After Intra-articular Fracture. Journal of the American Academy of Orthopaedic Surgeons, 22(1), 20–28. https://doi.org/10.5435/jaaos-22-01-20
  32. Zlowodzki, M., Bhandari, M., Marek, D. J., Cole, P. A., & Kregor, P. J. (2006). Operative Treatment of Acute Distal Femur Fractures: Systematic Review of 2 Comparative Studies and 45 Case Series (1989 to 2005). Journal of Orthopaedic Trauma, 20(5), 366–371. https://doi.org/10.1097/00005131-200605000-00013
  33. Gugenheim, J. J., Probe, R. A., & Brinker, M. R. (2004). The Effects of Femoral Shaft Malrotation on Lower Extremity Anatomy. Journal of Orthopaedic Trauma, 18(10), 658–664. https://doi.org/10.1097/00005131-200411000-00002
  34. Lee, T. Q., Anzel, S. H., Bennett, K. A., Pang, D., & Kim, W. C. (1994). The Influence of Fixed Rotational Deformities of the Femur on the Patellofemoral Contact Pressures in Human Cadaver Knees. Clinical Orthopaedics and Related Research, &NA;(302), 69-74. https://doi.org/10.1097/00003086-199405000-00013
  35. Papadopoulos, E. C., Parvizi, J., Lai, C. H., & Lewallen, D. G. (2002). Total knee arthroplasty following prior distal femoral fracture. The Knee, 9(4), 267–274. https://doi.org/10.1016/s0968-0160(02)00046-7
  36. Furuhashi, H., Kaneko, H., Iwata, K., & Hattori, T. (2020). Sagittal plane deformity after temporary epiphysiodesis of the distal femur for correcting limb length discrepancy. Journal of Orthopaedic Science, 25(3), 472–476. https://doi.org/10.1016/j.jos.2019.05.002
  37. Collinge, C. A., Gardner, M. J., & Crist, B. D. (2011). Pitfalls in the Application of Distal Femur Plates for Fractures. Journal of Orthopaedic Trauma, 25(11), 695–706. https://doi.org/10.1097/bot.0b013e31821d7a56
  38. GILES, L. G. F., & TAYLOR, J. R. (1981). Low-Back Pain Associated With Leg Length Inequality. Spine, 6(5), 510–521. https://doi.org/10.1097/00007632-198109000-00014
  39. Sherman, S. L., Thompson, S. F., & Clohisy, J. C. F. (2018). Distal Femoral Varus Osteotomy for the Management of Valgus Deformity of the Knee. Journal of the American Academy of Orthopaedic Surgeons, 26(9), 313–324. https://doi.org/10.5435/jaaos-d-16-00179
  40. Bakhshayesh, P., Sandberg, O., Kumar, V., Ali, A., & Enocson, A. (2019). Volume fusion of CT images to measure femoral symmetricity. Surgical and Radiologic Anatomy, 42(6), 635–639. https://doi.org/10.1007/s00276-019-02389-3
  41. Kamath, J., Danda, R. S., Jayasheelan, N., Singh, R. (2016). An Innovative Method of Assessing the Mechanical Axis Deviation in the Lower Limb in Standing Position. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 10 (6), RC11– RC13. https://doi.org/10.7860/jcdr/2016/17324.8042
  42. Van Criekinge, T., Winnock de Grave, P., Luyckx, T., & Claeys, K. (2022). Trunk control, motion and alignment after total knee arthroplasty: a systematic review and meta-analysis. Gait & Posture, 94, 173–188. https://doi.org/10.1016/j.gaitpost.2022.03.006
  43. Beltran, M. J., Gary, J. L., & Collinge, C. A. (2015). Management of Distal Femur Fractures With Modern Plates and Nails. Journal of Orthopaedic Trauma, 29(4), 165–172. https://doi.org/10.1097/bot.0000000000000302.
  44. Shih, Y. C., Chau, M. M., Arendt, E. A., & Novacheck, T. F. (2020). Measuring Lower Extremity Rotational Alignment. The Journal of Bone and Joint Surgery, 102(4), 343–356. https://doi.org/10.2106/jbjs.18.01115
  45. Haleem, A. M., Wiley, K. F., Kuchinad, R., & Rozbruch, S. R. (2017). Total Hip Arthroplasty in Patients With Multifactorial Perceived Limb Length Discrepancy. The Journal of Arthroplasty, 32(10), 3044–3051. https://doi.org/10.1016/j.arth.2017.04.036
  46. Mückley, T., Lerch, C., Gonschorek, O., Marintschev, I., Bühren, V., & Hofmann, G. O. (2005). Compression nailing for posttraumatic rotational femoral deformities: open versus minimally invasive technique. International Orthopaedics, 29(3), 168–173. https://doi.org/10.1007/s00264-005-0647-5
  47. Nelitz, M. (2018). Femoral Derotational Osteotomies. Current Reviews in Musculoskeletal Medicine, 11(2), 272–279. https://doi.org/10.1007/s12178-018-9483-2
  48. Stahl, J.-P., Alt, V., Kraus, R., Hoerbelt, R., Itoman, M., & Schnettler, R. (2006). Derotation of post-traumatic femoral deformities by closed intramedullary sawing. Injury, 37(2), 145–151. https://doi.org/10.1016/j.injury.2005.06.042
  49. Wixted, C. M., Peterson, J. R., Kadakia, R. J., & Adams, S. B. (2021). Three-dimensional Printing in Orthopaedic Surgery: Current Applications and Future Developments. JAAOS: Global Research and Reviews, 5(4), e20.00230-11. https://doi.org/10.5435/jaaosglobal-d-20-00230
  50. Yang, P., Du, D., Zhou, Z., Lu, N., Fu, Q., Ma, J., Zhao, L., & Chen, A. (2016). 3D printing-assisted osteotomy treatment for the malunion of lateral tibial plateau fracture. Injury, 47(12), 2816–2821. https://doi.org/10.1016/j.injury.2016.09.025
  51. Cha, M.-S., Song, S.-Y., Jung, K.-H., & Seo, Y.-J. (2019). Distal Femoral Medial Opening Wedge Osteotomy for Post-Traumatic, Distal Femoral Varus Deformity. Knee Surgery and Related Research, 31(1), 61–66. https://doi.org/10.5792/ksrr.18.023
  52. Miranda, M. A., DeAngelis, J. P., Canizares, G. H., & Mast, J. W. (2018). Double Oblique Osteotomy. Journal of Orthopaedic Trauma, 32, S60—S65. https://doi.org/10.1097/bot.0000000000001090
  53. Brinkman, J. M., Lobenhoffer, P., Agneskirchner, J. D., Staubli, A. E., Wymenga, A. B., & van Heerwaarden, R. J. (2008). Osteotomies around the knee. The Journal of Bone and Joint Surgery. British volume, 90-B(12), 1548–1557. https://doi.org/10.1302/0301-620x.90b12.21198
  54. Luna-Pizarro, D., Moreno-Delgado, F., De la Fuente-Zuno, J. C., & Meraz-Lares, G. (2012). Distal femoral dome varus osteotomy: Surgical technique with minimal dissection and external fixation. The Knee, 19(2), 99–102. https://doi.org/10.1016/j.knee.2011.01.005
  55. Sangeorzan, B. J., Sangeorzan, B. P., Hansen, S. T., & Judd, R. P. (1989). Mathematically Directed Single-Cut Osteotomy for Correction of Tibial Malunion. Journal of Orthopaedic Trauma, 3(4), 267–275. https://doi.org/10.1097/00005131-198912000-00001
  56. van der Woude, J. A. D., Spruijt, S., van Ginneken, B. T. J., & van Heerwaarden, R. J. (2016). Distal femoral valgus osteotomy: bone healing time in single plane and biplanar technique. Strategies in Trauma and Limb Reconstruction, 11(3), 177–186. https://doi.org/10.1007/s11751-016-0266-2
  57. Assayag M. J. (2018). Femur: essential tips, techniques, and pearls. In J. E. Herzenberg (Ed.), The art of limb alignment: Taylor spatial frame (pp. 201–212). Baltimore: Rubin Institute for Advanced Orthopedics.
  58. Nogueira, M., Hernandez, A., Pereira, C. M., Paley, D., & Bhave, A. (2016). Surgical decompression of the peroneal nerve in the correction of lower limb deformities: A cadaveric study. Journal of Limb Lengthening & Reconstruction, 2(2), 76. https://doi.org/10.4103/2455-3719.190708

How to Cite

Romanenko, K., & Doluda, Y. . (2023). MODERN TREATMENT OF POST-TRAUMATIC EXTRA-ARTICULAR DEFORMITY OF THE FEMUR. ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS, (1), 67–79. https://doi.org/10.15674/0030-59872023167-79

Issue

Section

ORIGINAL ARTICLES