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Functional outcome of open distal femoral fractures managed with lateral locking plates

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Abstract

Purpose

This prospective study evaluated the functional outcome and union rates of open distal femoral fractures managed with anatomic lateral locking plates.

Methods

Thirty-four patients with open distal femur fractures with mean age of 40.8 years (range 20–65 years) were included in the study. Patients with Gustilo–Anderson grade IIIC fractures and those managed with non-locking modalities were excluded. In total, 70.6% (n = 24) of the fractures were Type IIIA and 55.9% (n = 19) were AO/OTA Type C3 fractures. In 23.5% (n = 8) patients, knee spanning external fixator was applied initially before definitive fixation. Patients were followed up for a mean period of 11.6 months (range 8–22.5 months). Functional outcome was evaluated using Sanders Score.

Results

In the primary plating group, 69.2% (n = 18) fractures united at an average of 27 weeks (range 21–40 weeks), while eight patients had non-union and required bone grafting. All eight patients with external fixator underwent lateral locked plating with bone grafting and united at an average time of 39.6 weeks (range 31–50 weeks). There were two cases each of infection and screw failure. The final mean Sanders Score was 30.1 (range19–40) with 73.5% (n = 25) patients having good to excellent functional outcomes.

Conclusions

Lateral locking plates offer excellent stability to allow fracture union in open distal femoral fractures. A proactive approach to identify and manage potential healing difficulties is advisable to promote bone healing.

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References

  1. 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:S8–S14

    Article  PubMed  Google Scholar 

  2. Hoffmann MF, Jones CB, Sietsema DL et al (2013) Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res 8:43

    Article  PubMed Central  PubMed  Google Scholar 

  3. Ricci WM, Streubel PN, Morshed S et al (2014) Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 28:83–89

    Article  PubMed  Google Scholar 

  4. Singh A, Rastogi A, Singh V (2013) Biomechanical comparison of dynamic condylar screw and locking compression plate fixation in unstable distal femoral fractures: an in vitro study. Indian J Orthop 47:615–620

    Article  PubMed Central  PubMed  Google Scholar 

  5. Poole WEC, Wilson DGG, Guthrie HC et al (2017) ‘Modern’ distal femoral locking plates allow safe, early weight-bearing with a high rate of union and low rate of failure. Bone Joint J 99:B:951–B:957

    Article  PubMed  Google Scholar 

  6. Wenger D, Andersson S (2018) Low risk of nonunion with lateral locked plating of distal femoral fractures-a retrospective study of 191 consecutive patients. Injury. https://doi.org/10.1016/j.injury.2018.10.039

  7. Rodriguez EK, Boulton C, Weaver MJ et al (2014) Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury 45:554–559

    Article  PubMed  Google Scholar 

  8. Schatzker J (1998) Fractures of the distal femur revisited. Clin Orthop Relat Res:43–56

  9. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium - 2007: orthopaedic trauma association classification, database and outcomes committee. J Orthop Trauma 21:S1–S133

  10. Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24:742–746

    Article  CAS  PubMed  Google Scholar 

  11. Brasel KJ (2013) Advanced trauma life support (ATLS): the ninth edition. J Trauma Acute Care Surg 74:1363–1366

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  13. Elsoe R, Ceccotti AA, Larsen P (2018) Population-based epidemiology and incidence of distal femur fractures. Int Orthop 42:191–196

    Article  PubMed  Google Scholar 

  14. Koso RE, Terhoeve C, Steen RG, Zura R (2018) Healing, nonunion and re-operation after internal fixation of diaphyseal and distal femoral fractures: a systematic review and meta-analysis. Int Orthop 42:2675–2683

    Article  PubMed  Google Scholar 

  15. Dang KH, Armstrong CA, Karia RA, Zelle BA (2018) Outcomes of distal femur fractures treated with the Synthes 4.5 mm VA-LCP curved condylar plate. Int Orthop. https://doi.org/10.1007/s00264-018-4177-3

  16. Kanakaris NK, Obakponovwe O, Krkovic M et al (2018) Fixation of periprosthetic or osteoporotic distal femoral fractures with locking plates: a pilot randomised controlled trial. Int Orthop. https://doi.org/10.1007/s00264-018-4061-1

  17. Kim S-M, Yeom J-W, Song HK et al (2018) Lateral locked plating for distal femur fractures by low-energy trauma: what makes a difference in healing? Int Orthop 42:2907–2914

    Article  PubMed  Google Scholar 

  18. Barei DP, Beingessner DM (2012) Open distal femur fractures treated with lateral locked implants: union, secondary bone grafting, and predictive parameters. Orthopedics 35:e843–e846

    Article  PubMed  Google Scholar 

  19. Bhattacharyya T, Bouchard KA, Phadke A et al (2006) The accuracy of computed tomography for the diagnosis of tibial nonunion. J Bone Joint Surg Am 88:692–697

    PubMed  Google Scholar 

  20. Dugan TR, Hubert MG, Siska PA et al (2013) Open supracondylar femur fractures with bone loss in the polytraumatized patient - timing is everything! Injury 44:1826–1831

    Article  PubMed  Google Scholar 

  21. Vallier HA, Hennessey TA, Sontich JK, Patterson BM (2006) Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg Am 88:846–853

    PubMed  Google Scholar 

  22. Masquelet AC, Begue T (2010) The concept of induced membrane for reconstruction of long bone defects. Orthop Clin North Am 41:27–37

    Article  PubMed  Google Scholar 

  23. Olerud S (1972) Operative treatment of supracondylar--condylar fractures of the femur. Technique and results in fifteen cases. J Bone Joint Surg Am 54:1015–1032

    Article  CAS  PubMed  Google Scholar 

  24. Holzman MA, Hanus BD, Munz JW et al (2016) Addition of a medial locking plate to an in situ lateral locking plate results in healing of distal femoral nonunions. Clin Orthop Relat Res 474:1498–1505

    Article  PubMed Central  PubMed  Google Scholar 

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. Department Of Orthopaedics, Dayanand Medical College and Hospital, Tagore Nagar, Ludhiana, 141001, India

    Deepak Jain, Raghav Arora, Rajnish Garg, Pankaj Mahindra & Harpal S. Selhi

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  1. Deepak Jain
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  2. Raghav Arora
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  3. Rajnish Garg
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  4. Pankaj Mahindra
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  5. Harpal S. Selhi
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Correspondence to Raghav Arora.

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Informed consent was obtained from all individual participants included in the study.

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Jain, D., Arora, R., Garg, R. et al. Functional outcome of open distal femoral fractures managed with lateral locking plates. International Orthopaedics (SICOT) 44, 725–733 (2020). https://doi.org/10.1007/s00264-019-04347-5

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  • DOI: https://doi.org/10.1007/s00264-019-04347-5

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