Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions

Holzman, Michael; Hanus, Bryan D.; Munz, John W.; O’Connor, Daniel P.; Brinker, Mark R.

doi:10.1007/s11999-016-4709-3

Cited by 63 publications

(40 citation statements)

References 19 publications

(35 reference statements)

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“…Holzman et al reported that the complication rate in their study was 30% which is higher than the findings of the present study where we found complication rate was 20% of the cases. 7 Just the findings of the present study, this study also reported a very good union rate but slightly more rate of complications.…”

Section: Discussionsupporting

confidence: 80%

Prospective study of managing long bone fracture nonunion: is bone graft needed in every case?

Balagani

2018

Int J Res Orthop

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Background: Increased road traffic accidents lead to increased incidence of fracture of long bones. It has a tendency of non-union. Infection is very common in these cases which are an important cause of nonunion of long bone fractures. The objective of the study was to study the incidence and patterns of non-union of long bone fracture.Methods: Hospital based prospective study was carried out at Department of Orthopedics, from June 2017 to March 2018. Patients admitted to wards of Department of Orthopedics with nonunion of long bones were included. During the study period a total of 20 cases were eligible for the present study as per the inclusion and exclusion criteria.Results: Males were more affected than females. Most commonly affected age group was 41-50 years and 61-70 years (25% each). Most commonly affected long bone was femur in 35% of the cases. Most common type of non-union was hypertrophic (50%). Most common cause of non-union was broken implant in 35% of the cases. Maximum number of patients had union in 4-6 months in 60% of the cases after surgery of previous non-union of long bones. Only four patients developed complications like shortening of the limb or persistent non-union.Conclusions: Hypertrophic non unions doesn’t require bone graft, they require only stable fixation. For removal of broken implant in hypertrophic non-union if we open the fracture site, then even the gap after debridement of fracture site shows partial segmental defect it doesn’t require bone grafting.

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Section: Discussionsupporting

confidence: 80%

Prospective study of managing long bone fracture nonunion: is bone graft needed in every case?

Balagani

2018

Int J Res Orthop

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“…Nine studies reported outcomes of case series with double plating of femoral non-unions including the proximal femur, femoral shaft and distal femur [4,24,[39][40][41][42][43][44][45]. Pydisetty et al [42] analysed 10 patients with revision surgery for non-union of bisphosphonate-related subtrochanteric fractures.…”

Section: Non-union Of the Femurmentioning

confidence: 99%

Union rates and functional outcome of double plating of the femur: systematic review of the literature

Lodde

Raschke

Stolberg-Stolberg

et al. 2021

Arch Orthop Trauma Surg

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Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

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“…It is de ned as good when the both conditions can be reached, accept when one condition can be reached and poor with none condition can be reached. The imaging standard of fracture union 17 was de ned as the blur of fracture line on the X-ray plain lm, and the continuous callus passing through at least three cortical bone of the fracture site. The implant failure 18 de ned as that: lag screw cut out, coxa vara (The caput-collum-diaphysis angle less than 5°above the contralateral hip) or nonunion, implant broken, periprosthetic fracture without high energy damage.…”

Section: Data Collectionmentioning

confidence: 99%

Risk factors for implant failure of proximal femoral nail anti-rotation (PFNA –II) in the treatment of intertrochanteric fractures (AO/OTA 31 A1 and A2)

Nie

et al. 2020

Preprint

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Background Intertrochanteric fracture is associated with severe morbidity and mortality. The results of postoperative implant failure are catastrophic. The aim of this study was to determine risk factors for implant failure in intertrochanteric fractures treated with proximal femoral nail anti-rotation (PFNA–II) through the assessment of early therapeutic effects. Methods A single-center retrospective study was conducted on a continuous series of 123 intertrochanteric fracture patients treated with PFNA-II between Dec 2018 and Oct 2019. Perioperative medical and imaging data were collected. The patients were divided into two groups according to whether implant failure of not. The differences in reduction quality, nail length and tip apex distance (TAD) were analyzed to determine the risk factors of implant failure. Results A total of 80 patients were enrolled, with an average age of 80.2 years old. There were 6 patients with implant failure. There was no significant difference in demographic index between the two groups. The reduction quality of failure group was good, accept and poor with each 2 patients, and that of the non-failure group was 35, 35 and 4 patients respectively. The difference of reduction quality between the two groups was statistically significant. The risk of postoperative implant failure in patients with poor reduction quality was 8.75 times that of patients with good and acceptable reduction from the Logistic regression analysis(OR = 8.75,95%CI 1.215–62.99). The differences in nail length, ASA and bone quality were not statistically significant. Conclusion Reduction quality is a risk factor of implant failure in intertrochanteric fractures treated with PFNA-II. Even if the medial femoral cortex is anatomically reduced, there will be a triangular void area between the nail and the medial femur, which are prone to coxa vara and implant failure. Therefore, good reduction is the key to treat intertrochanteric fracture.

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Addition of a Medial Locking Plate to an In Situ Lateral Locking Plate Results in Healing of Distal Femoral Nonunions

Abstract: Background Nonunion of the distal femur after lateral plating is associated with axial malalignment, chronic pain, loss of ambulatory function, and decreased knee ROM.

Cited by 63 publications

References 19 publications

Prospective study of managing long bone fracture nonunion: is bone graft needed in every case?

Prospective study of managing long bone fracture nonunion: is bone graft needed in every case?

Union rates and functional outcome of double plating of the femur: systematic review of the literature

Risk factors for implant failure of proximal femoral nail anti-rotation (PFNA –II) in the treatment of intertrochanteric fractures (AO/OTA 31 A1 and A2)

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