Prognostic Factors for Reoperation After Distal Femur Fracture Fixation: A Systematic Review and Meta-Analysis.

JBJS RevNov 12, 2026 (epub)
Clinical ResearchOrthopedic Surgery

Hamzah Saad Algodi, Nellie Krougly, Lucas Drew et al.

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In 30 seconds

This systematic review and meta-analysis examined patient, fracture, and technical factors associated with reoperation for nonunion after distal femur fracture fixation in patients aged 16 years or older. It included 121 studies covering 9,749 fractures, with 18 studies contributing to meta-analysis. Moderate-certainty associations were reported for higher BMI (SMD 0.6, 95% CI 0.4-0.7), diabetes (aOR 2.3, 95% CI 0.8-6.0), open fracture (aOR 3.3, 95% CI 1.8-5.8), and stainless steel implants (aOR 6.1, 95% CI 4.0-9.3). Dual-implant constructs had better outcomes in selected adverse fracture settings, but evidence was limited.

Key findings

  • Open fracture was associated with reoperation for nonunion (aOR 3.3, 95% CI 1.8-5.8; moderate certainty).
  • Higher BMI (SMD 0.6, 95% CI 0.4-0.7) and diabetes (aOR 2.3, 95% CI 0.8-6.0) had moderate-certainty associations with reoperation.
  • Stainless steel implant material was associated with reoperation (aOR 6.1, 95% CI 4.0-9.3; moderate certainty).
  • Dual-implant constructs showed superior outcomes with metaphyseal comminution and medial column deficiency, although prognostic factors were not formally assessed in these cohorts.

Why it matters

The findings distinguish patient and fracture characteristics associated with reoperation from construct parameters, which showed few consistent independent associations. This may help frame risk assessment and highlight where evidence is most relevant to fixation decisions. However, the reported associations do not establish that changing a factor will prevent reoperation, and evidence for dual-implant use in high-risk settings remains incomplete.

What to keep in mind

Only 18 of the 121 included studies contributed to meta-analysis. Prognostic factors were not formally evaluated within the dual-implant cohorts, limiting conclusions about their benefit in specific high-risk groups.

Source

PubMed · PMID 43019571

Published in JBJS Rev. This summary was written by xxcode from the publication's abstract and metadata. It is not peer reviewed and is not a substitute for the original article. For clinical decisions, review the original publication.

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