Skip to main content

Advertisement

SpringerLink
Log in

Does the type of medial plate fixation matter for supplemental fixation of distal femur fractures manage with a lateral pre-contoured locked plate? A Biomechanical study

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

A Correction to this article was published on 11 October 2023

This article has been updated

Abstract

Introduction

Fixation of distal femur fractures with a lateral pre-contoured locking plate provides stable fixation and is the standard treatment in most cases, allowing early range of motion with a high rate of union. However, in situations, the stability achieved with the lateral plate alone may be insufficient, predisposing to fixation failure. The objective of the study was to compare, in synthetic bone models, the biomechanical behaviour of the fixation with a distal femur lateral pre-contoured locking plate solely and associated with a 3.5 mm proximal humeral locking plate applied upside down or a 4.5 mm helical locking compression plate on the medial side.

Material and methods

A total of 15 solid synthetic left femur samples were used. A metaphysical defect at the level of the medial cortex was simulated. The samples were randomly distributed into three groups equally. All groups received a 4.5/5.0 mm single lateral 9-hole distal femur lateral pre-contoured locking plate. Group 1 had no supplementary plate. Group 2 received a supplementary 6-hole 3.5 mm proximal humeral locking plate and Group 3 received a supplementary 4.5/5.0 mm helical 14-hole narrow locking compression plate.

Results

Both supplementary plate types used in groups 2 and 3 contributed to increase the apparent stiffness of the construct, but pairwise comparison showed statically significant difference only between group 1 and 3. No significant difference was observed between groups 2 and 3.

Conclusion

Both supplementary plates might be considered for improving the fixation in distal femur fracture in selected cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Availability of data and material

All data generated and analysed during this study are included in this published article and are available from the corresponding author on reasonable request.

Change history

References

  1. Bellabarba C, Ricci WM, Bolhofner BR (2002) Indirect reduction and plating of distal femoral nonunions. J Orthop Trauma 16(5):287–296. https://doi.org/10.1097/00005131-200205000-00001

    Article  PubMed  Google Scholar 

  2. Hoffmann MF, Jones CB, Sietsema DL, Tornetta P 3rd, Koenig SJ (2013) Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res 8:43. https://doi.org/10.1186/1749-799X-8-43

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ (2014) Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 28(2):83–89. https://doi.org/10.1097/BOT.0b013e31829e6dd0

    Article  PubMed  Google Scholar 

  4. Tank JC, Schneider PS, Davis E, Galpin M, Prasarn ML, Choo AM, Munz JW, Achor TS, Kellam JF, Gary JL (2016) Early mechanical failures of the synthes variable angle locking distal femur plate. J Orthop Trauma 30(1):e7–e11. https://doi.org/10.1097/BOT.0000000000000391

    Article  PubMed  Google Scholar 

  5. Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL (2011) Locking plates for distal femur fractures: Is there a problem with fracture healing? J Orthop Trauma 25(Suppl 1):S8-14. https://doi.org/10.1097/BOT.0b013e3182070127

    Article  PubMed  Google Scholar 

  6. Ruoff AC 3rd, Biddulph EC (1972) Dual plating of selected femoral fractures. J Trauma 12(3):233–241. https://doi.org/10.1097/00005373-197203000-00007

    Article  PubMed  Google Scholar 

  7. Sanders R, Swiontkowski M, Rosen H, Helfet D (1991) Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Jt Surg Am 73(3):341–346

    Article  CAS  Google Scholar 

  8. Liporace FA, Yoon RS (2019) Nail plate combination technique for native and periprosthetic distal femur fractures. J Orthop Trauma 33(2):e64–e68. https://doi.org/10.1097/BOT.0000000000001332

    Article  PubMed  Google Scholar 

  9. Lenz M, Stoffel K, Gueorguiev B, Klos K, Kielstein H, Hofmann GO (2016) Enhancing fixation strength in periprosthetic femur fractures by orthogonal plating - a biomechanical study. J Orthop Res 34(4):591–596. https://doi.org/10.1002/jor.23065

    Article  PubMed  Google Scholar 

  10. Ziran BH, Rohde RH, Wharton AR (2002) Lateral and anterior plating of intra-articular distal femoral fractures treated via an anterior approach. Int Orthop 26(6):370–373. https://doi.org/10.1007/s00264-002-0383-z

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Ael-S K, Ayoub MA (2012) Highly unstable complex C3-type distal femur fracture: Can double plating via a modified Olerud extensile approach be a standby solution? J Orthop Traumatol 13(4):179–188. https://doi.org/10.1007/s10195-012-0204-0

    Article  Google Scholar 

  12. Steinberg EL, Elis J, Steinberg Y, Salai M, Ben-Tov T (2017) A double-plating approach to distal femur fracture: a clinical study. Injury 48(10):2260–2265. https://doi.org/10.1016/j.injury.2017.07.025

    Article  PubMed  Google Scholar 

  13. Pires RE, Giordano V (2022) Nail-plate combination and double plating for complex distal femur fractures (native or periprosthetic). In: Stannard JP, Schmidt A, Kfuri M (eds) Knee surgery – tricks of the trade. Thieme Medical Publishers, Inc., New York

    Google Scholar 

  14. Muizelaar A, Winemaker MJ, Quenneville CE, Wohl GR (2015) Preliminary testing of a novel bilateral plating technique for treating periprosthetic fractures of the distal femur. Clin Biomech (Bristol, Avon) 30(9):921–926. https://doi.org/10.1016/j.clinbiomech.2015.07.008

    Article  PubMed  Google Scholar 

  15. Park KH, Oh CW, Park IH, Kim JW, Lee JH, Kim HJ (2019) Additional fixation of medial plate over the unstable lateral locked plating of distal femur fractures: a biomechanical study. Injury 50(10):1593–1598. https://doi.org/10.1016/j.injury.2019.06.032

    Article  PubMed  Google Scholar 

  16. Todorov D, Zderic I, Richards RG, Lenz M, Knobe M, Enchev D, Baltov A, Gueorguiev B, Stoffel K (2018) Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures? J Orthop Res 36(10):2604–2611. https://doi.org/10.1002/jor.24047

    Article  CAS  PubMed  Google Scholar 

  17. Fontenot PB, Diaz M, Stoops K, Barrick B, Santoni B, Mir H (2019) Supplementation of lateral locked plating for distal femur fractures: a biomechanical study. J Orthop Trauma 33(12):642–648. https://doi.org/10.1097/BOT.0000000000001591

    Article  PubMed  Google Scholar 

  18. Zhang J, Wei Y, Yin W, Shen Y, Cao S (2018) Biomechanical and clinical comparison of single lateral plate and double plating of comminuted supracondylar femoral fractures. Acta Orthop Belg 84(2):141–148

    PubMed  Google Scholar 

  19. Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS (2003) Biomechanical testing of the LCP–how can stability in locked internal fixators be controlled? Injury 34(Suppl 2):B11–B19. https://doi.org/10.1016/j.injury.2003.09.021

    Article  PubMed  Google Scholar 

  20. Giordano V, Alves DD, Paes RP, Amaral AB, Giordano M, Belangero W, Freitas A, Koch HA (2019) The role of the medial plate for Pauwels type III femoral neck fracture: a comparative mechanical study using two fixations with cannulated screws. J Exp Orthop. 6(1):18. https://doi.org/10.1186/s40634-019-0187-3

    Article  PubMed  PubMed Central  Google Scholar 

  21. Giordano V, Paes RP, Alves DD, Amaral AB, Belangero WD, Giordano M, Freitas A, Koch HA (2018) Stability of L-shaped and inverted triangle fixation assemblies in treating Pauwels type II femoral neck fracture: a comparative mechanical study. Eur J Orthop Surg Traumatol 28(7):1359–1367. https://doi.org/10.1007/s00590-018-2207-x

    Article  PubMed  Google Scholar 

  22. Hohenberger GM, Schwarz AM, Grechenig P, Clement B, Staresinic M, Bakota B (2021) Medial minimally invasive helical plate osteosynthesis of the distal femur - a new technique. Injury 52(Suppl 5):S27–S31. https://doi.org/10.1016/j.injury.2020.02.051

    Article  PubMed  Google Scholar 

  23. Jiamton C, Apivatthakakul T (2015) The safety and feasibility of minimally invasive plate osteosynthesis (MIPO) on the medial side of the femur: a cadaveric injection study. Injury 46(11):2170–2176. https://doi.org/10.1016/j.injury.2015.08.032

    Article  CAS  PubMed  Google Scholar 

  24. Pastor T, Beeres FJP, Kastner P, Gehweiler D, Migliorini F, Nebelung S, Scaglioni MF, Souleiman F, Link BC, Babst R, Gueorguiev B, Knobe M (2022) Anatomical analysis of different helical plate designs for distal femoral fracture fixation. Injury 53(7):2636–2641. https://doi.org/10.1016/j.injury.2022.03.033

    Article  PubMed  Google Scholar 

  25. Rollick NC, Gadinsky NE, Klinger CE, Kubik JF, Dyke JP, Helfet DL, Wellman DS (2020) The effects of dual plating on the vascularity of the distal femur. Bone Joint J 102-B(4):530–538. https://doi.org/10.1302/0301-620X.102B4.BJJ-2019-1776

    Article  PubMed  Google Scholar 

  26. Pires RE, Yoon RS, Liporace FA, Balbachevsky D, Bitar RC, Giordano V, Wajnsztejn A, Kfuri M (2020) Expanding the horizons of clinical applications of proximal humerus locking plates in the lower extremities: a technical note. Chin J Traumatol 23(6):331–335. https://doi.org/10.1016/j.cjtee.2020.08.001

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lenz M, Varga P, Mischler D, Gueorguiev B, Klos K, Fernandez dell’Oca A, Regazzoni P, Richards RG, Perren SM (2021) Helical plating - a novel technique to increase stiffness in defect fractures. Eur Cell Mater 42:110–121. https://doi.org/10.22203/eCM.v042a08

    Article  CAS  PubMed  Google Scholar 

  28. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H (1997) Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study. Injury 28(Suppl 1):A7-12. https://doi.org/10.1016/s0020-1383(97)90110-8

    Article  PubMed  Google Scholar 

  29. Beeres FJP, Emmink BL, Lanter K, Link BC, Babst R (2020) Minimally invasive double-plating osteosynthesis of the distal femur. Oper Orthop Traumatol 32(6):545–558. https://doi.org/10.1007/s00064-020-00664-w

    Article  PubMed  Google Scholar 

  30. Chapman JR, Henley MB (1994) Double plating of distal femur fractures: indications and technique. Tec Orthop 9(3):210–216

    Article  Google Scholar 

  31. Quesada A, Videla Ávila F, Horue Pontoriero G, Filisetti JE (2022) Helical plate osteosynthesis in distal femur fractures. Rev Asoc Argent Ortop Traumatol 87(2):285–293. https://doi.org/10.15417/issn.1852-7434.2022.87.2.150

    Article  Google Scholar 

  32. Gueorguiev B, Zderic I, Pastor T, Gehweiler D, Richards G, Knobe M (2021) Double plating of unstable distal femoral fractures: Is augmented lateral plating with a helically shaped medial plate biomechanically advantageous over a straight medial plate? Orthop Procs 103-B:24–24. https://doi.org/10.1302/1358-992X.2021.13.024

    Article  Google Scholar 

  33. Redondo-Trasobares B, Sarasa-Roca M, Rosell-Pradas J, Calvo-Tapies J, Gracia-Villa L, Albareda-Albared J (2023) Estudio comparativo clínico y biomecánico de distintos tipos de osteosíntesis en el tratamiento de fracturas distales de fémur. Rev Esp Cir Ortop Traumatol 67:216–225. https://doi.org/10.1016/j.recot.2023.01.003

    Article  CAS  PubMed  Google Scholar 

  34. Wiss DA, Fleming CH, Matta JM, Clark D (1986) Comminuted and rotationally unstable fractures of the femur treated with an interlocking nail. Clin Orthop Relat Res 212:35–47

    Article  Google Scholar 

  35. Streubel PN, Gardner MJ, Morshed S, Collinge CA, Gallagher B, Ricci WM (2010) Are extreme distal periprosthetic supracondylar fractures of the femur too distal to fix using a lateral locked plate? J Bone Joint Surg Br 92(4):527–534. https://doi.org/10.1302/0301-620X.92B3.22996

    Article  CAS  PubMed  Google Scholar 

  36. Wright DJ, DeSanto DJ, McGarry MH, Lee TQ, Scolaro JA (2020) Supplemental fixation of supracondylar distal femur fractures: a biomechanical comparison of dual-plate and plate-nail constructs. J Orthop Trauma 34(8):434–440. https://doi.org/10.1097/BOT.0000000000001749

    Article  PubMed  Google Scholar 

  37. Henry Goodnough L, Salazar BP, Chen MJ, Storaci H, Guzman R, Heffner M, Tam K, DeBaun MR, Gardner MJ (2021) Supplemental medial small fragment fixation adds stability to distal femur fixation: a biomechanical study. Injury 52(7):1670–1672. https://doi.org/10.1016/j.injury.2021.04.056

    Article  CAS  PubMed  Google Scholar 

  38. Cristofolini L, Viceconti M, Cappello A, Toni A (1996) Mechanical validation of whole bone composite femur models. J Biomech 29(4):525–535. https://doi.org/10.1016/0021-9290(95)00084-4

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

This study was fully supported by the AO Trauma Latin America.

Author information

Authors and Affiliations

  1. Servicio de Ortopedia y Traumatologia, Sanatorio San Lucas, Belgrano 369, B1642, San Isidro, Buenos Aires, Argentina

    Sebastián Pereira

  2. Servicio de Ortopedia y Traumatologia, Hospital Sirio-Libanes, Campana 4658, C1419, Buenos Aires, Argentina

    Sebastián Pereira & Fernando Bidolegui

  3. Servicio de Ortopedia y Traumatologia, Sanatorio Otamendi Miroli, Azcuénaga 870, C1115, Buenos Aires, Argentina

    Fernando Bidolegui

  4. Servicio de Ortopedia y Traumatologia, Hospital Británico de Buenos Aires, Perdriel 74, C1280 AEB, Buenos Aires, Argentina

    Germán Garabano & Cesar Angel Pesciallo

  5. Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil

    Vincenzo Giordano

  6. Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil

    Robinson Estevez Pires

  7. Biomaterials Laboratory in Orthopedics (LABIMO), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil

    José Ricardo Mariolani & William Dias Belangero

  8. Department of Orthopedics, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil

    William Dias Belangero

Authors
  1. Sebastián Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando Bidolegui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Germán Garabano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cesar Angel Pesciallo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincenzo Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robinson Estevez Pires
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. José Ricardo Mariolani
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. William Dias Belangero
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study's conception and design. Material preparation, data collection, and analysis were performed by Sebastian Pereira, Ricardo Mariolani and William Belangero. Sebastian Pereira wrote the first draft of the manuscript and all authors commented on previous version of the manuscript. Vincenzo Giordano and Sebastian Pereira wrote the revision of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Sebastián Pereira.

Ethics declarations

Conflict of interest

All authors have certified that they have no conflict of interest to declare that are relevant to the content of this article.

Ethics approval

N/A.

Consent data

N/A.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pereira, S., Bidolegui, F., Garabano, G. et al. Does the type of medial plate fixation matter for supplemental fixation of distal femur fractures manage with a lateral pre-contoured locked plate? A Biomechanical study. Eur J Orthop Surg Traumatol 34, 605–612 (2024). https://doi.org/10.1007/s00590-023-03685-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-023-03685-w

Keywords

Search

Navigation