Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

Abstract

Distal femoral fractures have typically a bimodal occurrence: in young people due to a high-energy trauma and in older people related to a low-energy trauma. These fractures are associated to a very high morbidity and mortality in elderly. Distal femoral fractures might be treated with plates, intramedullary nails, external fixations, and prosthesis. However, difficulties in fracture healing and the rate of complications are important clinical issues. The purpose of this retrospective review was to present our experience in treatment of distal femoral fracture in a sample of older people in order to evaluate the technical pitfalls and strategies used to face up the fractures unsuccessfully treated with locking plates. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. We considered 'unsuccessfully treated' the cases with healing problems or hardware failures. Of the 12 patients (9 females and 3 males; mean aged 68.75 ± 3.31 years) included, we observed 3 'unsuccessfully cases', 2 due to nonunions and 1 due to an early hardware failure, all treated using a condylar blade plate with a bone graft. One patient obtained a complete fracture healing after 1 year and in the other cases there was a nonunion. We observed as most common technical pitfalls: inadequate plate lengthening, fracture bridging, and number of locking screws. The use of locking plates is an emerging technique to treat these fractures but it seems more challenging than expected. In literature there is a lack of evidences about the surgical management of distal femoral fractures that is still an important challenge for the orthopaedic surgeon that has to be able to use all the fixation devices available.

How to improve the outcomes of surgically treated proximal humeral osteoporotic fractures? A narrative review

“…The advent of locking plates (LP) represented a relevant evolution in the treatment of osteoporotic fractures. 29 Their use in PHF is potentially indicated for all reconstructable fractures, except in cases with significant comminution, head split or impaction that did do not allow a stable synthesis. It has been observed that patients with valgus impaction have better outcomes than those with varus impaction fractures.…”

Pre-operative planning for fracture fixation using locking plates: device configuration and other considerations

“…With increased callus formation, the bone will transmit an increasing proportion of the load [56]. If fracture healing does not occur or is delayed, then the plate must support all applied loading and plate breakage will eventually occur [22]. Previous experimental studies that have considered load-bearing scenarios have found that more rigid constructs perform better under cyclic loading [41,51,54,59].…”

“…It is well accepted that the majority of locked plating failures are due to inappropriate device configuration for the fracture pattern [21][22][23][24][25]. Several studies cite screw positioning variables such as the number and spacing of screws as responsible for cases of locking plate breakage, screw loosening, and periprosthetic re-fracture [3,8,[26][27][28][29].…”

Pitfalls in Distal Femur Fracture Fixation and a Literature Review

“…He should know the fracture segments of condyles and any comminution in articular surface or metaphyseal segment. Sometimes it is better to bypass comminution with bridging technique (14). If you miss this comminution and open it, risk of nonunion will highly increase.…”