Zanchini F, Piscopo A, Cipolloni V, Fusini F, Cacciapuoti S, Piscopo D, Pripp C, Nasto LA, Pola E. Distal femur complex fractures in elderly patients treated with megaprosthesis: Results in a case series of 11 patients. World J Orthop 2022; 13(5): 454-464 [PMID: 35633750 DOI: 10.5312/wjo.v13.i5.454]
Corresponding Author of This Article
Enrico Pola, PhD, Professor, Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Via del Sole 10, Naples 80138, Italy. enrico.pola@unicampania.it
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2022; 13(5): 454-464 Published online May 18, 2022. doi: 10.5312/wjo.v13.i5.454
Distal femur complex fractures in elderly patients treated with megaprosthesis: Results in a case series of 11 patients
Fabio Zanchini, Antonio Piscopo, Valerio Cipolloni, Federico Fusini, Stefano Cacciapuoti, Davide Piscopo, Charlotte Pripp, Luigi Aurelio Nasto, Enrico Pola
Fabio Zanchini, Davide Piscopo, Luigi Aurelio Nasto, Enrico Pola, Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Naples 80138, Italy
Antonio Piscopo, Stefano Cacciapuoti, Department of Orthopedics and Traumatology, Sacro Cuore di Gesù Fatebenefratelli Hospital, Benevento 82100, Italy
Valerio Cipolloni, Spine Division, Department of Orthopaedics and Traumatology, A. Gemelli IRCCS University Hospital, Catholic University of Rome, Rome 00168, Italy
Federico Fusini, Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Mondovì 12084, Italy
Charlotte Pripp, Service de Geriatrie et réaaptation HUG, Hôpital de Bellerive Chem, Genève 1205, Switzerland
Author contributions: Pola E and Zanchini F participated in the conceptualization; Piscopo A participated in surgical technique development; Cipolloni V and Nasto LA participated in methodology and writing-original preparation; Pola E participated in validation; Cipolloni V and Piscopo D participated in formal analysis and investigation; Cipolloni V and Pripp C participated in data curation; Nasto LA participated in writing–review and editing; Pola E, Piscopo A and Cacciapuoti S participated in supervision; All authors have read and agreed to the published version of the manuscript.
Institutional review board statement: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of our Institution.
Informed consent statement: The informed consent statement was waived.
Conflict-of-interest statement: The authors declare no conflict of interest.
Data sharing statement: Data will be made available upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Enrico Pola, PhD, Professor, Orthopaedics and Traumatology Division, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania "Luigi Vanvitelli" School of Medicine, Via del Sole 10, Naples 80138, Italy. enrico.pola@unicampania.it
Received: December 29, 2021 Peer-review started: December 29, 2021 First decision: February 21, 2022 Revised: March 19, 2022 Accepted: April 27, 2022 Article in press: April 27, 2022 Published online: May 18, 2022 Processing time: 134 Days and 20.4 Hours
ARTICLE HIGHLIGHTS
Research background
Treatment of complex distal femur fractures in the elderly is debated. Currently available techniques (i.e. retrograde nailing, plate and screws fixation, delayed knee replacement surgery) are plagued by poor outcomes. More recently, megaprosthesis have been used for treatment of major trauma and their use has been investigated in treatment of distal femur fractures as well.
Research motivation
There is a lack of short to long term outcomes studies on the use of megaprosthesis for treatment of complex distal femur fractures in the elderly.
Research objectives
The aim of this study is to critically review our clinical experience with usage of megaprosthesis for treatment of complex distal femur fractures in a series of 11 elderly patients.
Research methods
We conducted a retrospective review of 11 consecutive patients older than 85-years-old for treatment with knee megaprosthesis at our institution. Patients were followed-up on an average for 23 mo after surgery. Clinical and radiographical outcome measures were assessed. Mortality was also recorded.
Research results
No deaths were recorded in our case series. At the time of the last follow-up all patients were walking either independently or with walking aids. The average Oxford Knee Score at the time of the last follow-up was 36.8 points. The average Visual Analogical Scale score at the time of the last follow-up was 1.9 points.
Research conclusions
Knee megaprosthesis in the setting of complex distal femur fractures in elderly patients is a valid solution which is able to offer short operative times and hospital stays.
Research perspectives
Longer follow-up studies will be needed to further validate our results. Furthermore, case-controlled studies (i.e. magaprosthesis vs standard plate fixation) would be useful to compare clinical outcomes between these two techniques.
