Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort

Abstract

BackgroundPlate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method.MethodsThis retrospective study included 71 distal femoral fractures of 70 patients who were treated with the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Univariate analysis was performed on them.ResultsOf 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non-union. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm.Non-union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p = 0.06). In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes.ConclusionsWe concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate.

Efficacy of retrograde intramedullary femoral nailing and locking plates in the treatment of distal femoral fracture: a systematic review and meta analysis

“…In conclusion, there was no significant difference in clinical efficacy between RIN and locking plats in treating distal femoral fracture. These two implants have their own advantages, RIN has obvious biomechanical advantages over locking plates, but, the locking plate is better choice for the treatment of osteoporotic distal femoral fractures in the elderly 26 .…”

Case Report of Surgical Treatment of Spiral Fracture of Medial Femoral Condyle by ORIF Using Lag Screws and Posterior Buttress Tibial Plate in Elderly Lady and Review of Literature

“…In elderly patients with osteoporosis a low energy trauma causes simple spiral or oblique fractures the shape of distal femur when viewed end on is a trapezoid with posterior part wide then the anterior part creating 25 degree of inclination on the middle surface and about 10 degree on the lateral surface the plate should lie flat on this lateral surface [6,7], a line that is drawn from anterior aspect of the lateral femoral condyle to the anterior aspect of the medial femoral condyle patellofemoral inclination slopes posteriorly approximately 10 degrees [8,9] this anatomical details are important when inserting any implant or plates, knowledge of the normal radiographic joint line angle helps to assess alignment during an operation the normal anatomical axis of femoral shaft relative to the knee or the anatomical lateral distal femoral angle(LDFA) is 80 to 84 degrees. Measured contralateral lateral distal femoral angle (LDFA) can be used for reference as assessment of coronal alignment, there is consistent pattern of mismatch at the proximal part of the 11-hole locking compression plate for distal femur that may cause valgus malalignment [10].…”

Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

“…In addition, it would be useful if all studies on distal femur fractures would specify the weight-bearing strategy used, which is currently not the case. 12,[56][57][58][59] Based on available knowledge regarding the effects of restrictive and non-restrictive weight-bearing discussed in the preceding paragraphs, it seems reasonable to suggest nonrestrictive weight-bearing for elderly patients with distal femur fractures. Non-restrictive weight-bearing might, however, not be appropriate for all patients.…”

“…In addition, it would be useful if all studies on distal femur fractures would specify the weight-bearing strategy used, which is currently not the case. 12 , 56 - 59 …”