Risk Factors for Reoperation to Promote Union in 1111 Distal Femur Fractures

Abstract

Objectives: To identify modifiable and nonmodifiable risk factors for reoperation to promote union after distal femur fracture.

Design: Multicenter retrospective cohort study.

Setting: Ten Level-I trauma centers.

Patients/participants: Patients with OTA/AO 33A or C distal femur fractures (n = 1111).

Intervention: Surgical fixation of distal femur fracture. Fixation constructs were classified as lateral plate, dual plate, nail, or nail plate combination.

Main outcome measurements: The outcome of interest was unplanned reoperation to promote union.

Results: There was an 11% (121/1111) rate of unplanned reoperation to promote union. In the multivariate analysis, predictive factors included body mass index [odds ratio (OR) = 1.18; 95% confidence interval (CI), 1.06-1.32; P < 0.01], intra-articular fracture (OR = 1.57; 95% CI, 1.01-2.45; P = 0.04), type III open injury (OR = 2.29; 95% CI, 1.41-3.72; P < 0.01), the presence of medial comminution (OR = 1.85; 95% CI, 1.14-3.06; P = 0.01), and medial translation on postoperative radiographs (OR = 1.23 per one 10th of condylar width; 95% CI, 1.01-1.48; P = 0.03). Construct type was not significantly predictive.

Conclusions: Eleven percent of distal femur fractures underwent unplanned reoperation to promote union. Body mass index, intra-articular fracture, type III open injury, medial comminution, and medial translation on postoperative radiographs were predictive factors. Construct type was not associated with unplanned reoperation; however, this conclusion was limited by small numbers in the dual plate and nail plate groups.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.