The use of the 95-degree-angled blade plate in femoral nonunion surgery

  • Louis F. Amorosa
  • Prem R. Jayaram
  • David S. Wellman
  • Dean G. Lorich
  • David L. Helfet
Original Article



The 95-degree-fixed angle blade plate has been in use for decades for both acute femoral fractures and nonunions. Our objective was to examine the results of use by a single surgeon of the 95-degree-angled blade plate in proximal and distal femoral nonunion surgery.

Patients and methods

The nonunion database of a single surgeon over a 16 year period was used to identify all proximal and distal femoral nonunions that were treated with open reduction and internal fixation using the 95-degree-angled blade plate. There were 78 cases in which the blade plate was used, and 68 of 78 (87.2 % follow-up rate) were followed to a final outcome, which was defined as complete healing of the nonunion, conversion to arthroplasty, or amputation. Failure was defined as revision surgery for persistence of nonunion, conversion to arthroplasty prior to healing, or amputation. Three patients who failed were lost to follow-up prior to a final outcome.


In the 71 patients who were followed to failure or complete follow-up, the rate of healing with one surgery was 77.5 % (55 of 71). Eight of 16 failures required a second surgery for persistence of nonunion and eventually went on to heal the nonunion. Eleven of the 16 failures were in patients who had a known infected nonunion. When the 21 cases of infected nonunions were excluded, the healing rate for aseptic nonunions with one surgery alone using the 95-degree-angled blade plate was 91.2 % (52 of 57) compared with 47.6 % (10 of 21) in the infected nonunion group (p < 0.0001). Eleven patients who had healed their nonunion underwent all or partial removal of the implant for irritation or prominence.


The 95-degree-angled blade plate is an effective reduction aid and fixation device for aseptic nonunions of the proximal and distal femur with acceptable healing rates with one surgery alone.


Femoral nonunion 95-degree-angled blade plate Periarticular locking plates 


Conflict of interest



  1. 1.
    Altenberg AR, Shorkey RL (1949) Blade-plate fixation in non-union and in complicated fractures of the supracondylar region of the femur. J Bone Joint Surg Am 31A(2):312–316PubMedGoogle Scholar
  2. 2.
    Berkes MB, Little MT, Lazaro LE, Cymerman RM, Helfet DL, Lorich DG (2012) Catastrophic failure after open reduction internal fixation of femoral neck fractures with a novel locking plate implant. J Orthop Trauma. doi: 10.1097/BOT.0b013e31823b4cd1 PubMedGoogle Scholar
  3. 3.
    Button G, Wolinsky P, Hak D (2004) Failure of less invasive stabilization system plates in the distal femur: a report of four cases. J Orthop Trauma 18(8):565–570PubMedCrossRefGoogle Scholar
  4. 4.
    Ebraheim NA, Liu J, Hashmi SZ, Sochacki KR, Moral MZ, Hirschfeld AG (2012) High complication rate in locking plate fixation of lower periprosthetic distal femur fractures in patients with total knee arthroplasties. J Arthroplasty 27(5):809–813. doi: 10.1016/j.arth.2011.08.007 PubMedCrossRefGoogle Scholar
  5. 5.
    Ehlinger M, Adam P, Arlettaz Y, Moor BK, DiMarco A, Brinkert D, Bonnomet F (2011) Minimally-invasive fixation of distal extra-articular femur fractures with locking plates: limitations and failures. Orthop Traumatol Surg Res 97(6):668–674. doi: 10.1016/j.otsr.2011.05.004 PubMedCrossRefGoogle Scholar
  6. 6.
    Forward DP, Doro CJ, O’Toole RV, Kim H, Floyd JC, Sciadini MF (2012) A biomechanical comparison of a locking plate, a nail, and a 95 degrees angled blade plate for fixation of subtrochanteric femoral fractures. J Orthop Trauma 26(6):334–340. doi: 10.1097/BOT.0b013e3182254ea3 PubMedCrossRefGoogle Scholar
  7. 7.
    Glassner PJ, Tejwani NC (2011) Failure of proximal femoral locking compression plate: a case series. J Orthop Trauma 25(2):76–83. doi: 10.1097/BOT.0b013e3181e31ccc PubMedCrossRefGoogle Scholar
  8. 8.
    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–S14. doi: 10.1097/BOT.0b013e3182070127 PubMedCrossRefGoogle Scholar
  9. 9.
    Kammerlander C, Gebhard F, Meier C, Lenich A, Linhart W, Clasbrummel B, Blauth M (2011) Standardised cement augmentation of the PFNA using a perforated blade: a new technique and preliminary clinical results. A prospective multicentre trial. Injury 42(12):1484–1490. doi: 10.1016/j.injury.2011.07.010 Google Scholar
  10. 10.
    Mast J, Jakob R, Ganz R (1989) Planning and Reduction Technique in Fracture Surgery. Springer, BerlinCrossRefGoogle Scholar
  11. 11.
    Shroeder JE, Mosheiff R, Khoury A, Liebergall M, Weil YA (2009) The outcome of closed, intramedullary exchange nailing with reamed insertion in the treatment of femoral shaft nonunions. J Orthop Trauma 23(9):653–657. doi: 10.1097/BOT.0b013e3181a2a337 PubMedCrossRefGoogle Scholar
  12. 12.
    Struijs PA, Poolman RW, Bhandari M (2007) Infected nonunion of the long bones. J Orthop Trauma 21(7):507–511. doi: 10.1097/BOT.0b013e31812e5578 PubMedCrossRefGoogle Scholar
  13. 13.
    Vallier HA, Immler W (2012) Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma 26(6):327–332. doi: 10.1097/BOT.0b013e318234d460 PubMedCrossRefGoogle Scholar
  14. 14.
    Wahnert D, Hoffmeier K, Frober R, Hofmann GO, Muckley T (2011) Distal femur fractures of the elderly–different treatment options in a biomechanical comparison. Injury 42(7):655–659. doi: 10.1016/j.injury.2010.09.009 PubMedCrossRefGoogle Scholar
  15. 15.
    Weresh MJ, Hakanson R, Stover MD, Sims SH, Kellam JF, Bosse MJ (2000) Failure of exchange reamed intramedullary nails for ununited femoral shaft fractures. J Orthop Trauma 14(5):335–338PubMedCrossRefGoogle Scholar
  16. 16.
    Zickel RE (1988) Nonunions of fractures of the proximal and distal thirds of the shaft of the femur. Instr Course Lect 37:173–179PubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Louis F. Amorosa
    • 1
  • Prem R. Jayaram
    • 1
  • David S. Wellman
    • 1
  • Dean G. Lorich
    • 1
  • David L. Helfet
    • 1
  1. 1.Orthopaedic Trauma Service, Hospital for Special SurgeryNew YorkUSA

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