Opinions Regarding Dual-Implant Fixation and Weight-Bearing in Distal Femur Fractures: A Survey From the 2022 Orthopaedic Trauma Association Traveling Fellowship.

Abstract

To describe current opinions of staff orthopaedic trauma surgeons on the surgical treatment of distal femur fractures, with attention to indications for dual-implant constructs, application techniques, and postoperative rehabilitation. A 22-question survey was given to fellowship-trained orthopaedic trauma surgeons at institutions visited by the 2022 Orthopaedic Trauma Association Fellows to characterize opinions on techniques, indications, and postoperative weight-bearing status for five example distal femur fractures. Demographic data were collected. Participants responses on implants and weight-bearing were recorded. Opinions on technique of dual-implant fixation were collected. The survey was returned by 57 surgeons. Most respondents preferred a single implant (retrograde intramedullary nails or lateral locked plate) and weight-bearing as tolerated for the extra-articular and periprosthetic fracture. The preference for dual-implant fixation increased with metaphyseal bone loss (46%) and for nonunion treatment (53%). Articular involvement had the strongest effect on weight-bearing (17% weight-bearing as tolerated with simple articular split, 6% with articular comminution). Respondents preferred a retrograde intramedullary nails plus lateral locked plate over dual-plate fixation. Rationale for dual-implant fixation were early mobilization (32%), poor distal fixation (32%), and absent medial column support (30%). This survey of current practice among institutions participating in the 2022 Orthopaedic Trauma Association Traveling Fellowship demonstrates that common fracture-related indications for dual-implant fixation include nonunion treatment and comminuted fractures with bone loss. The ability for earlier mobilization, poor fixation, and lack of medial column support were the most common indications for dual-implant fixation. This survey highlights the need for further studies investigating best treatment for distal femur fractures and sets the stage for future studies of dual-implant constructs. V, descriptive survey study.