Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial

Hanschen, Marc; Aschenbrenner, Ina M.; Fehske, Kai; Kirchhoff, Sonja; Keil, Leonhard; Holzapfel, Boris Michael; Winkler, Sebastian; Fuechtmeier, Bernd; Neugebauer, R; Luehrs, Sven; Liener, U. C.; Biberthaler, Peter

doi:10.1007/s00264-013-2210-0

Cited by 42 publications

(21 citation statements)

References 21 publications

(20 reference statements)

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“…The aspect of plating can also be extended to the question of single vs double plating respectively mono vs polyaxial locking plates in periprosthetic fractures as mono axial plates often used in combination with double plating was preferred in some cases so far. Hanschen et al could demonstrate that single plating with polyaxial locking plates in complex distal femur fractures leads to good functional and clinical results [ 21 ]. Regarding the soft tissue management as well as the outcome in the treatment of Felix fractures so far, the transfer of this aspect to the tibial side should be well considered.…”

Section: Discussionmentioning

confidence: 99%

Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Schreiner

Schmidutz

Ateschrang

et al. 2018

BMC Musculoskelet Disord

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BackgroundPeriprosthetic fractures after total knee arthroplasty (TKA) are an increasing problem and challenging to treat. The tibial side is commonly less affected than the femoral side wherefore few studies and case reports are available. The aim of this study was to analyze the outcome of periprosthetic tibial fractures and compare our data with current literature.MethodsAll periprosthetic tibial TKA fractures that were treated at our Level 1 Trauma Center between 2011 and 2015 were included and analyzed consecutively. The Felix classification was used to assess the fracture type and evaluation included the radiological and clinical outcome (Knee Society Score/KSS, Oxford Knee Score/OKS).ResultsFrom a total of 50 periprosthetic TKA fractures, 9 cases (7 female, 2 male; 2 cruciate retaining, 7 constrained TKAs) involving the tibial side were identified. The mean age in this group was 77 (65–85) years with a follow-up rate of 67% after a mean of 22 (0–36) months. The Felix classification showed type IB (n = 1), type IIB (n = 2), type IIIA (n = 4) and type IIIB (n = 2) and surgical intervention included ORIF (n = 6), revision arthroplasty (n = 1), arthrodesis (n = 1) and amputation (n = 1). The rate of adverse events and revision was 55.6% including impaired wound healing, infection and re-fracture respectively peri-implant fracture. Main revision surgery included soft tissue surgery, arthrodesis, amputation and re-osteosynthesis. The clinical outcome showed a mean OKS of 29 (19–39) points and a functional/knee KSS of 53 (40–70)/41 (17–72) points. Radiological analyses showed 4 cases of malalignment after reduction and plate fixation.ConclusionsPeriprosthetic tibial fractures predominantly affect elderly patients with a reduced bone quality and reveal a high complication rate. Careful operative planning with individual solutions respecting the individual patient condition is crucial. If ORIF with a plate is considered, restoration of the correct alignment and careful soft tissue management including minimal invasive procedures seem important factors for the postoperative outcome.

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Section: Discussionmentioning

confidence: 99%

Periprosthetic tibial fractures in total knee arthroplasty – an outcome analysis of a challenging and underreported surgical issue

Schreiner

Schmidutz

Ateschrang

et al. 2018

BMC Musculoskelet Disord

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“…That can often leads to positioning of screws in bone areas which intraoperatively have to be considered of minor quality. This may be associated with secondary loss of realignment and loosening of screws[ 15 ]. Ideas to avoid this and giving the surgeon more freedom in directing the screws through the bone lead to the introduction of polyaxial locking plates[ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Mono- versus polyaxial locking plates in distal femur fractures – a biomechanical comparison of the Non-Contact-Bridging- (NCB) and the PERILOC-plate

El-Zayat¹,

Efe²,

Ruchholtz

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe aim of this cadaveric study was to compare a polyaxial (NCB®, Zimmer) to a fixed-angle monoaxial locking plate (PERILOC®, Smith & Nephew) in comminuted fractures of the distal femur regarding stability of the construct. Up to date there is no published biomechanical data concerning polyaxial plating in cadaveric distal femurs.MethodsFourteen formalin fixed femora were scanned by dual-energy x-ray absorptiometry. As fracture model an unstable supracondylar comminuted fracture was simulated. Fractures were pairwise randomly fixed either with a mono- (group A) or a polyaxial (group B) distal femur plate. The samples were tested in a servohydraulic mechanical testing system starting with an axial loading of 200 N following an increase of 200 N in every step with 500 cycles in every sequence up to a maximum of 2 000 N. The end points were implant failure or relevant loss of reduction. Data records included for each specimen time, number of cycles, axial load and axial displacement. Statistical analysis was performed using the exact Wilcoxon signed rank test.ResultsThe mean donor age at the time of death was 75 years. The bone mass density (BMD) of the femurs in both groups was comparable and showed no statistically significant differences. Five bones failed before reaching the maximum applied force of 2000 N. Distribution curves of all samples in both groups, showing the plastic deformation in relation to the axial force, showed no statistically significant differences.ConclusionsOperative stabilization of distal femur fractures can be successfully and equally well achieved using either a monoaxial or a polyaxial locking plate. Polyaxial screw fixation may have advantages if intramedullary implants are present.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-369) contains supplementary material, which is available to authorized users.

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“…To the editor, Hanschen et al [1] have done an excellent study on monoversus polyaxial locking plates in distal femur fractures, which found the polyaxial treatment tended to result in better functional and radiological outcome. However, we have some concerns regarding the paper and wish to share them.…”

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confidence: 99%