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Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial

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Abstract

Purpose

Treatment of complex fractures of the distal femur utilizing monoaxial locking plates (e.g. Less Invasive Stabilisation System, LISS®, Synthes) is considered to be superior to conventional plating systems. Due to the limitation that the thread forces the screw into pre-determined positions, modifications have been made to allow screw positioning within a range of 30° (Non Contact Bridging, NCB®-DF, Zimmer). For the first time, this multicenter prospective randomized clinical trial (RCT) investigates the outcome of LISS® vs. NCB®-DF treatment following complex fractures of the distal femur.

Methods

Since June 2008, 27 patients with a fracture of the distal femur (AO ASIF 33-A-C and periprosthetic fractures) were enrolled in this study by four university trauma centres in southern Germany. Clinical (e.g. range of motion, Oxford knee score, Tegner score) and radiological (e.g. axis deviation, secondary loss of realignment) follow-ups were conducted one and six weeks, as well as three, six, and 12 months after the operation.

Results

This study comprises data of 27 patients (8 male, 19 female; 15 NCB®-DF, 12 LISS®). Polyaxial osteosynthesis using the NCB® system tended to result in better functional knee scores and a higher range of motion. Interestingly, fracture union tended to be more rapid using the polyaxial plating system.

Conclusions

We present the analysis of a multicenter prospective RCT to compare the monoaxial LISS® vs. the polyaxial NCB®-DF treatment following complex fractures of the distal femur. NCB®-DF treatment tended to result in better functional and radiological outcomes than LISS® treatment.

Level of Evidence

Level I

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Acknowledgments

The authors thank A. Berglehner, F. Gebhard, R. Meffert, and W. Mutschler for their valuable advice and support.

Conflict of interest

PB is a surgical instructor in AO courses on the LISS®-system as well as for the Zimmer institute on the NCB®-system. The entire study was independently conducted and did not receive any financial aid whatsoever.

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Authors and Affiliations

  1. Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany

    Marc Hanschen, Ina M. Aschenbrenner & Peter Biberthaler

  2. Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Clinics of Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany

    Kai Fehske & Boris M. Holzapfel

  3. Department of Clinical Radiology, Ludwig-Maximilians-University, Nussbaumstr. 20, 80336, Munich, Germany

    Sonja Kirchhoff

  4. Department of Trauma and Orthopaedic Surgery, Ludwig-Maximilians-University, Nussbaumstr. 20, 80336, Munich, Germany

    Leonhard Keil

  5. Department of Trauma and Orthopaedic Surgery, Hospital Barmherzige Brueder, Pruefeninger Str. 86, 93049, Regensburg, Germany

    Sebastian Winkler, Bernd Fuechtmeier & Rainer Neugebauer

  6. Department of Trauma, Hand, Plastic and Reconstructive Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Sven Luehrs & Ulrich Liener

Authors
  1. Marc Hanschen
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  2. Ina M. Aschenbrenner
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  3. Kai Fehske
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  4. Sonja Kirchhoff
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  5. Leonhard Keil
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  6. Boris M. Holzapfel
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  7. Sebastian Winkler
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  8. Bernd Fuechtmeier
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  9. Rainer Neugebauer
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  10. Sven Luehrs
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  11. Ulrich Liener
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  12. Peter Biberthaler
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Corresponding author

Correspondence to Marc Hanschen.

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Hanschen, M., Aschenbrenner, I.M., Fehske, K. et al. Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial. International Orthopaedics (SICOT) 38, 857–863 (2014). https://doi.org/10.1007/s00264-013-2210-0

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  • DOI: https://doi.org/10.1007/s00264-013-2210-0

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