股骨远端骨折通常用接骨术治疗。然而,在老年膝关节骨性关节炎患者中,急性初次全膝关节置换术(TKA)可用于治疗这些骨折.值得注意的是,没有研究证明在膝关节骨性关节炎患者的股骨远端骨折的治疗中使用骨固定术联合股骨远端截骨术(DFO).本报告介绍了一名66岁的女性,患有外侧间室骨关节炎并伴有严重的外翻膝关节畸形,该女性接受了股骨远端骨折的骨合成术,并结合了内侧闭合楔形股骨远端截骨术(MCWDFO)以纠正膝关节外翻畸形。由于跌倒,她的右膝股骨远端骨折(AO/OTA33B1.1)。在受伤之前,由于严重的膝盖疼痛,她表现出跛行,膝盖屈曲有一定的局限性。整个下肢的非负重射线照片表明机械轴百分比(%MA)为115%,表明严重的外翻畸形。受伤后的第九天,我们对股骨远端骨折进行了骨固定,并进行了MCWDFO以矫正右膝外翻畸形.在MCWDFO之后,%MA校正为70%。术后三周开始部分负重,并在六周后发展到完全负重。为了促进骨骼愈合,术后3个月应用低强度脉冲超声(LIPUS).到第5个月,骨愈合成功。一些膝关节内侧疼痛在手术后持续了六个月;尽管如此,病人可以走路而不跛行。我们认为MCWDFO与骨连接术的整合可以为股骨远端骨折和外侧间室骨关节炎的患者提供治疗选择。
Distal femoral fractures are commonly treated with
osteosynthesis. However, in older patients with osteoarthritis of the knee, acute primary total knee arthroplasty (TKA) may be performed to treat these fractures. Notably, no studies have documented the use of
osteosynthesis in combination with distal femoral osteotomy (DFO) for treating distal femoral fractures in patients with knee osteoarthritis. This report presents the
case of a 66-year-old woman with lateral compartment osteoarthritis accompanied by severe valgus knee deformity who underwent
osteosynthesis for a distal femoral fracture combined with medial closing-wedge distal femoral osteotomy (MCWDFO) to correct the knee valgus deformity. She experienced a distal femoral fracture (AO/OTA 33B1.1) of the right knee because of a fall. Before the injury, she exhibited a limp due to severe knee pain with some limitations in knee flexion. Non-weight-bearing radiographs of the entire lower extremity suggested a percentage mechanical axis (%MA) of 115%, indicating severe valgus deformity. On day nine after the injury, we performed osteosynthesis for the distal femoral fracture and conducted an MCWDFO to correct the right knee valgus deformity. After MCWDFO, the %MA was corrected to 70%. Partial weight-bearing was initiated three weeks postoperatively and progressed to full weight-bearing at six weeks. To facilitate bone healing, low-intensity pulsed ultrasound (LIPUS) was applied for three months after surgery. Bone union was successfully achieved by month five. Some medial knee pain persisted for six months after surgery; nonetheless, the patient could walk without a limp. We considered that the integration of MCWDFO with
osteosynthesis could provide a treatment option for patients with distal femoral fractures and lateral compartment osteoarthritis.