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Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

Indian Journal of Orthopaedics volume 50, pages 374–378 (2016)Cite this article

Abstract

Background

When primary fxation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insuffcient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fxation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the effcacy of this implant in salvage situations.

Materials and Methods

Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery.

Results

All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fxation of proximal femoral fractures exhibiting nonunion.

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Affiliations

  1. Department of Orthopaedics, Noble Hospital, 153, Magarpatta City Road, Hadapsar, Pune, 411 013, Maharashtra, India

    Sampat S. Dumbre Patil, Sachin S. Karkamkar, Vaishali S. Dumbre Patil, Shailesh S. Patil & Abhijeet S. Ranaware

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  1. Sampat S. Dumbre Patil
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  2. Sachin S. Karkamkar
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  3. Vaishali S. Dumbre Patil
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  4. Shailesh S. Patil
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  5. Abhijeet S. Ranaware
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Correspondence to Sampat S. Dumbre Patil.

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Patil, S.S.D., Karkamkar, S.S., Patil, V.S.D. et al. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures. IJOO 50, 374–378 (2016). https://doi.org/10.4103/0019-5413.185598

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  • DOI: https://doi.org/10.4103/0019-5413.185598

Key words

  • Reverse distal femur locking compression plate
  • ipsilateral femoral neck and shaft fracture
  • nonunion fracture proximal femur
  • proximal femur fracture

MeSH terms

  • Osteosysthesis
  • bone plates
  • subtrochanteric fractures
  • orthopedic equipment