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Reversed distal femoral locking plate for failed proximal femoral nail with non-union of proximal femoral fractures

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Abstract

Introduction

Failure of proximal femoral fracture managed by proximal femoral nail (PFN) leads to a very difficult situation to handle with conventional techniques, and reversed distal femoral locking compression plate (DF-LCP) is of great benefit in these selective cases.

Methods

Twelve patients with ununited proximal femoral fractures including subtrochanteric fractures with a failed PFN implant were included in the study. All patients with periprosthetic fractures and fractures treated by implants other than PFN were excluded from this study.

Result

All fractures went into union in an average time of nine months and 15 days with no implant failures. The mean time of re-osteosynthesis after the primary index surgery of PFN was one year eight months. Mean surgical time of re-osteosynthesis was 110 minutes, and average blood loss during surgery was 550 ml.

Discussion

The PFM is one of the most commonly used implant for unstable proximal femur fractures. The use of PFN is technically demanding and is associated with high failure rates. Although dynamic compression screw (DCS), proximal femoral locking plate (PF-LCP) and other implants can be used in these failed situations, they are associated with a high complication rate. The reversed DF-LCP is a rescue implant for these complex situations. Apart from anatomical and biomechanical advantages, there are several other clinical benefits of using DF-LCP.

Conclusion

We conclude that DF-LCP is a potential and safe implant of choice for the management of nonunion associated with failed PFN. It may be considered an implant of choice as rescue from such a complex situation. It offers several anatomical, biomechanical and clinical advantages over other available conventional implants.

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The author(s) declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi, India, 110076

    Raju Vaishya, Amit Kumar Agarwal, Nishint Gupta & Vipul Vijay

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  1. Raju Vaishya
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  2. Amit Kumar Agarwal
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  3. Nishint Gupta
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  4. Vipul Vijay
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Correspondence to Amit Kumar Agarwal.

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Vaishya, R., Agarwal, A.K., Gupta, N. et al. Reversed distal femoral locking plate for failed proximal femoral nail with non-union of proximal femoral fractures. International Orthopaedics (SICOT) 40, 1709–1715 (2016). https://doi.org/10.1007/s00264-015-3002-5

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  • DOI: https://doi.org/10.1007/s00264-015-3002-5

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