Analysis of 101 Mechanical Failures in Distal Femur Fractures Treated with 3 Generations of Precontoured Locking Plates

Reeb, Alexander Francis; Collinge, Cory; Rodriguez-Buitrago, Andres; Archdeacon, Michael T.; Beltran, Michael J.; Gardner, Michael J.; Jeray, Kyle J.; Miller, Anna N.; Crist, Brett D.; Sems, Stephen A.; Shah, Nihar S.; Fogel, Nathaniel; Tibbo, Meagan E.

doi:10.1097/bot.0000000000002460

Cited by 5 publications

(8 citation statements)

References 25 publications

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“…Consequently, more than two-thirds of distal femur nonunions show mechanical hardware failure due to implant fatigue. 2 Implant failure typically occurs greater than 6 months after treatment; however, implant failures can occur as early as 6 weeks after fracture fixation. 1 Late implant failures together with fracture nonunion indicate fatigue failure.…”

Section: Distal Femur Fracture Fixation: Biomechanical Considerationsmentioning

confidence: 99%

Distal femur fractures: basic science and international perspectives

Nauth,

Haller,

Augat

et al. 2024

OTA International

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Distal femur fractures are challenging injuries to manage, and complication rates remain high. This article summarizes the international and basic science perspectives regarding distal femoral fractures that were presented at the 2022 Orthopaedic Trauma Association Annual Meeting. We review a number of critical concepts that can be considered to optimize the treatment of these difficult fractures. These include biomechanical considerations for distal femur fixation constructs, emerging treatments to prevent post-traumatic arthritis, both systemic and local biologic treatments to optimize nonunion management, the relative advantages and disadvantages of plate versus nail versus dual-implant constructs, and finally important factors which determine outcomes. A robust understanding of these principles can significantly improve success rates and minimize complications in the treatment of these challenging injuries.

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Section: Distal Femur Fracture Fixation: Biomechanical Considerationsmentioning

confidence: 99%

Distal femur fractures: basic science and international perspectives

Nauth,

Haller,

Augat

et al. 2024

OTA International

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“…The fundamental objectives of surgery will be to achieve a good reduction of the joint surfaces, maintain the length of the femur, as well as alignment and rotation; achieving knee stability that allows rapid mobilization [9]. Stabilization in the sagittal plane with rotation of the condyles, unlike stabilization in the frontal plane, represents a challenge for the surgeon [21].…”

Section: Managementmentioning

confidence: 99%

“…The distal femur is going to be subjected to torsional forces and a lot of axial load, which will condition a high varus stress [21]. If we anticipate long consolidation times, sometimes a lateral plate does not tolerate the situation and suffers from fatigue, and the use of medial plates or intramedullary nails with or without a lateral plate will provide additional fixation that will improve our results (Figure 10) [23].…”

Section: Fracture Fixation and Approachesmentioning

confidence: 99%

Distal Femoral Fractures

Reyes¹,

González-Alonso²,

Amhaz-Escanlar³

et al. 2023

Topics in Trauma Surgery

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Distal femur fractures are increasing injuries in our environment, due to their close relationship with the aging of the population. The diagnosis and treatment of these injuries have evolved in recent years, and the availability of new tools allows us to improve the results of our patients. Techniques such as dual nail-plate or plate-plate fixation emerge as an option in complications and complex fractures, and augmentation with PMMA may be an option in very low-density bones. To use these new techniques, anatomical knowledge, especially of the medial aspect of the femur, is essential. Many recent publications have studied the use of minimally invasive techniques with safe pathways. Throughout the following pages, we give a glimpse of the novelties in the treatment of these fractures, and we review the classic concepts.

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“…1 Although early studies yielded promising results, 2–4 recent studies have reported nonunion rates of 10%–22%. 5–10 Nonmodifiable risk factors for nonunion include obesity, open fractures, and fractures with medial comminution. 6,8–10…”

Section: Introductionmentioning

confidence: 99%

“…1 Although early studies yielded promising results, [2][3][4] recent studies have reported nonunion rates of 10%-22%. [5][6][7][8][9][10] Nonmodifiable risk factors for nonunion include obesity, open fractures, and fractures with medial comminution. 6,[8][9][10] Retrograde intramedullary nails are an alternative form of fixation for distal femur fractures.…”

Section: Introductionmentioning

confidence: 99%

Nail Plate Combination Fixation Versus Lateral Locked Plating for Distal Femur Fractures: A Multicenter Experience

Shi,

Brodke,

O'Hara

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: To (1) report on clinical, radiographic, and functional outcomes after nail-plate fixation (NPF) of distal femur fractures and (2) compare outcomes after NPF with a propensity matched cohort of fractures treated with single precontoured lateral locking plates. Design: Multicenter retrospective cohort study. Setting: Ten Level 1 trauma centers. Patients/Participants: Patients with OTA/AO 33A or 33C fractures. Intervention: Fixation with (1) retrograde intramedullary nail combined with lateral locking plate (n = 33) or (2) single precontoured lateral locking plate alone (n = 867). Main Outcome Measurements: The main outcomes of interest were all-cause unplanned reoperation and presence of varus collapse at final follow-up. Results: One nail-plate patient underwent unplanned reoperation excluding infection and 2 underwent reoperation for infection at an average of 57 weeks after surgery. No nail-plate patients required unplanned reoperation to promote union and none exhibited varus collapse. More than 90% were ambulatory with no or minimal pain at final follow-up. In comparison, 7 of the 30 matched lateral locked plating patients underwent all-cause unplanned reoperation excluding infection (23% vs. 3%, P = 0.023), and an additional 3 lateral locked plating patients were found to have varus collapse on final radiographs (10% vs. 0%, P = 0.069). Conclusions: Despite a high proportion of high-energy, open, and comminuted fractures, no NPF patients underwent unplanned reoperation to promote union or demonstrated varus collapse. Propensity score matched analysis revealed significantly lower rates of nonunion for NPF compared with lateral locked plating alone. Larger studies are needed to identify which distal femur fracture patients would most benefit from NPF. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Analysis of 101 Mechanical Failures in Distal Femur Fractures Treated with 3 Generations of Precontoured Locking Plates

Abstract: Objectives: To evaluate mechanical treatment failure in a large patient cohort sustaining a distal femur fracture treated with a distal femoral locking plate (DFLP).

Cited by 5 publications

References 25 publications

Distal femur fractures: basic science and international perspectives

Distal femur fractures: basic science and international perspectives

Distal Femoral Fractures

Nail Plate Combination Fixation Versus Lateral Locked Plating for Distal Femur Fractures: A Multicenter Experience

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