Early effectiveness of mini-Swashbuckler approach for distal femoral type C fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIANG Chao , JIANG Ke , CHEN Qian , LI Yuling , BAI Hanlin ,  CHEN Lu

Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong Sichuan, 637000, P.R.China;

Corresponding author：

CHEN Lu, Email: 59272025@qq.com

Keywords：

Distal femoral fracture; mini-Swashbuckler approach; Swashbuckler approach; less invasive stabilization system plate; internal fixation

DOI：

10.7507/1002-1892.201902073

Video：

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Objective To explore the early effectiveness and advantages of mini-Swashbuckler approach in treatment of distal femoral type C fractures by comparing with Swashbuckler approach.Methods A retrospective analysis was made on 43 patients with distal femoral type C fractures between January 2014 and June 2018. Twenty-two patients were treated with open reduction via mini-Swashbuckler approach and internal fixation with less invasive stabilization system (LISS) plate in modified group; and 21 patients were treated with open reduction via Swashbuckler approach and internal fixation with LISS plate in traditional group. There was no significant difference in age, gender, cause of trauma, fracture classification, fracture side, interval between injury and operation, and complications between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, hospitalization time, fracture healing time, Hospital for Special Surgery (HSS) scores of the knee, and postoperative complications were recorded and compared between the two groups.Results The operation successfully completed in both groups. The operation time of the modified group was significantly longer than that of the traditional group, the fluoroscopy times was increased and the blood loss was reduced, the differences were significant (P<0.05). There was no significant difference in hospitalization time between the two groups (t=0.277, P=0.783). All patients in the two groups were followed up 6-8 months, with an average of 7.2 months. Fractures healed in both groups, there was no significant difference in healing time between the two groups (t=0.861, P=0.394). The HSS scores of the modified group were 82.91±2.88 and 89.28±3.63 at 3 and 6 months after operation, respectively, which were superior to those of the traditional group (74.62±3.64) and (81.48±4.55) (t=8.306, P=0.000; t=6.231, P=0.000). There was 1 case of incision infection, 1 case of deep vein thrombosis, and 2 cases of knee flexion and extension dysfunction in traditional group, and 1 case of deep vein thrombosis, 1 case of varus deformity, and 1 case of internal fixation loosening in modified group. There was no significant difference in the incidences of complications between the two groups (P>0.05).Conclusion Compared with Swashbuckler approach, mini-Swashbuckler approach has limited visual field exposure, which leads to prolonged operation time and increased fluoroscopy times, but the risks of complications do not increase. Because of its small soft tissue injury and less blood loss, it is conducive to the recovery of knee joint function after operation.

Citation： XIANG Chao, JIANG Ke, CHEN Qian, LI Yuling, BAI Hanlin, CHEN Lu. Early effectiveness of mini-Swashbuckler approach for distal femoral type C fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(9): 1127-1132. doi: 10.7507/1002-1892.201902073 Copy

1.	Pietu G, Lebaron M, Flecher X, et al. Epidemiology of distal femur fractures in France in 2011-12. Orthop Traumatol Surg Res, 2014, 100(5): 545-548.
2.	Martinet O, Cordey J, Harder Y, et al. The epidemiology of fractures of the distal femur. Injury, 2000, 31 Suppl 3: C62-63.
3.	Mostofi SB. Fracture classifications in clinical practice. 2nd ed. London: Springer, 2006: 53-54.
4.	Rademakers MV, Kerkhoffs GM, Sierevelt IN, et al. Intra-articular fractures of the distal femur: a long-term follow-up study of surgically treated patients. J Orthop Trauma, 2004, 18(4): 213-219.
5.	任高宏, 林昂如, 裴国献, 等. 股骨远端复杂骨折的手术治疗. 中华创伤杂志, 2003, 19(11): 669-672.
6.	Bolhofner BR, Carmen B, Clifford P. The results of open reduction and internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma, 1996, 10(6): 372-377.
7.	Frederick M. Azar, James H. Beaty, S. Terry Canale. 坎贝尔骨科手术学. 第 6 卷. 13 版. 唐佩福, 等译. 北京: 北京大学医学出版社, 2018: 2617-2628.
8.	Starr AJ, Jones AL, Reinert CM. The " swashbuckler”: a modified anterior approach for fractures of the distal femur. J Orthop Trauma, 1999, 13(2): 138-140.
9.	Beltran MJ, Blair JA, Huh J, et al. Articular exposure with the swashbuckler versus a " Mini-swashbuckler” approach. Injury, 2013, 44(2): 189-193.
10.	Schütz M, Müller M, Regazzoni P, et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orthop Trauma Surg, 2005, 125(2): 102-108.
11.	Vallier HA, Hennessey TA, Sontich JK, et al. Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg (Am), 2006, 88(4): 846-853.
12.	Kanamiya T, Whiteside LA, Nakamura T, et al. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res, 2002, (404): 24-31.
13.	Khalil MA, Farid W, Gad S. Swashbuckler approach and surgical technique in severely comminuted fractures of the distal femur. Current Orthopaedic Practice, 2015, 26(3): 269-276.
14.	Weight M, Collinge C. Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma, 2004, 18(8): 503-508.
15.	Valles JF, Rodríguez FR, Gómez JM. Distal femur fractures. Comparative analysis of two different surgical treatments. Acta Ortop Mex, 2010, 24(5): 324-330.
16.	骆松, 戴闽, 丁志辉, 等. 新型股骨远端前外侧入路治疗股骨远端 C 型骨折疗效分析. 中国修复重建外科杂志, 2014, 28(4): 414-418.
17.	张斌, 戴闽, 邹帆, 等. 新型股骨远端前外侧入路治疗股骨远端骨折疗效观察. 中国修复重建外科杂志, 2013, 27(11): 1296-1299.
18.	周宗科, 翁习生, 向兵, 等. 中国髋、膝关节置换术加速康复─围术期贫血诊治专家共识. 中国骨与关节外科杂志, 2016, 9(1): 10-15.
19.	Conlon NP, Bale EP, Herbison GP, et al. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old. Anesth Analg, 2008, 106(4): 1056-1061.
20.	贝朝涌, 王锐英, 唐际存, 等. 股骨远端骨折术后膝关节功能恢复影响因素分析. 中国修复重建外科杂志, 2009, 23(9): 1053-1057.
21.	Young A, Stokes M, Iles JF. Effects of joint pathology on muscle. Clin Orthop Relat Res, 1987, (219): 21-27.
22.	Nicoll EA. Quadricepsplasty. J Bone Joint Surg (Br), 1963, 45(8): 483-490.

1. Pietu G, Lebaron M, Flecher X, et al. Epidemiology of distal femur fractures in France in 2011-12. Orthop Traumatol Surg Res, 2014, 100(5): 545-548.
2. Martinet O, Cordey J, Harder Y, et al. The epidemiology of fractures of the distal femur. Injury, 2000, 31 Suppl 3: C62-63.
3. Mostofi SB. Fracture classifications in clinical practice. 2nd ed. London: Springer, 2006: 53-54.
4. Rademakers MV, Kerkhoffs GM, Sierevelt IN, et al. Intra-articular fractures of the distal femur: a long-term follow-up study of surgically treated patients. J Orthop Trauma, 2004, 18(4): 213-219.
5. 任高宏, 林昂如, 裴国献, 等. 股骨远端复杂骨折的手术治疗. 中华创伤杂志, 2003, 19(11): 669-672.
6. Bolhofner BR, Carmen B, Clifford P. The results of open reduction and internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma, 1996, 10(6): 372-377.
7. Frederick M. Azar, James H. Beaty, S. Terry Canale. 坎贝尔骨科手术学. 第 6 卷. 13 版. 唐佩福, 等译. 北京: 北京大学医学出版社, 2018: 2617-2628.
8. Starr AJ, Jones AL, Reinert CM. The " swashbuckler”: a modified anterior approach for fractures of the distal femur. J Orthop Trauma, 1999, 13(2): 138-140.
9. Beltran MJ, Blair JA, Huh J, et al. Articular exposure with the swashbuckler versus a " Mini-swashbuckler” approach. Injury, 2013, 44(2): 189-193.
10. Schütz M, Müller M, Regazzoni P, et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orthop Trauma Surg, 2005, 125(2): 102-108.
11. Vallier HA, Hennessey TA, Sontich JK, et al. Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg (Am), 2006, 88(4): 846-853.
12. Kanamiya T, Whiteside LA, Nakamura T, et al. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res, 2002, (404): 24-31.
13. Khalil MA, Farid W, Gad S. Swashbuckler approach and surgical technique in severely comminuted fractures of the distal femur. Current Orthopaedic Practice, 2015, 26(3): 269-276.
14. Weight M, Collinge C. Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma, 2004, 18(8): 503-508.
15. Valles JF, Rodríguez FR, Gómez JM. Distal femur fractures. Comparative analysis of two different surgical treatments. Acta Ortop Mex, 2010, 24(5): 324-330.
16. 骆松, 戴闽, 丁志辉, 等. 新型股骨远端前外侧入路治疗股骨远端 C 型骨折疗效分析. 中国修复重建外科杂志, 2014, 28(4): 414-418.
17. 张斌, 戴闽, 邹帆, 等. 新型股骨远端前外侧入路治疗股骨远端骨折疗效观察. 中国修复重建外科杂志, 2013, 27(11): 1296-1299.
18. 周宗科, 翁习生, 向兵, 等. 中国髋、膝关节置换术加速康复─围术期贫血诊治专家共识. 中国骨与关节外科杂志, 2016, 9(1): 10-15.
19. Conlon NP, Bale EP, Herbison GP, et al. Postoperative anemia and quality of life after primary hip arthroplasty in patients over 65 years old. Anesth Analg, 2008, 106(4): 1056-1061.
20. 贝朝涌, 王锐英, 唐际存, 等. 股骨远端骨折术后膝关节功能恢复影响因素分析. 中国修复重建外科杂志, 2009, 23(9): 1053-1057.
21. Young A, Stokes M, Iles JF. Effects of joint pathology on muscle. Clin Orthop Relat Res, 1987, (219): 21-27.
22. Nicoll EA. Quadricepsplasty. J Bone Joint Surg (Br), 1963, 45(8): 483-490.

Chinese Journal of Reparative and Reconstructive Surgery

Early effectiveness of mini-Swashbuckler approach for distal femoral type C fractures

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