Biomechanical and anatomical considerations for dual plating of distal femur fractures: a systematic literature review

DeKeyser, Graham J.; Hakim, Anne J; O’Neill, Dillon C.; Schlickewei, Carsten; Marchand, Lucas S.; Haller, Justin M.

doi:10.1007/s00402-021-03988-9

Cited by 27 publications

(24 citation statements)

References 46 publications

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“…These results are especially encouraging given the biomechanical advantage demonstrated by dual plating in several recent biomechanics studies. [4,[7][8][9][10][11][12] In addition, the studies in the current review used the stringent inclusion/exclusion criteria limited to primarily complex intraarticular or highly comminuted extra-articular fractures, which may suggest that dual plating could provide a reliable fixation strategy in injuries at risk for failure when treated with other fixation constructs. However, higher-quality, prospective research is required to confirm these hypotheses.…”

Section: Discussionmentioning

confidence: 99%

“…Several recent biomechanical studies have demonstrated increased stiffness and decreased fracture motion characteristics for DP relative to LLP, as well as compared with reamed intramedullary nails and plate–nail combinations. [4,7–12] These biomechanical characteristics may be advantageous in the setting of early weight-bearing for osteoporotic fractures and for comminuted, high-energy injuries without load sharing potential. In addition, despite traditional concerns regarding dysvascularity associated with a separate medial approach to the distal femur, multiple recent anatomic and imaging studies have shown that there is a relatively wide safe zone for minimally invasive medial plate application without significant vascular disruption.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, despite traditional concerns regarding dysvascularity associated with a separate medial approach to the distal femur, multiple recent anatomic and imaging studies have shown that there is a relatively wide safe zone for minimally invasive medial plate application without significant vascular disruption. [5,[12][13][14][15][16] Existing clinical research on medial and lateral DP of the distal femur has been primarily limited to small case series and retrospective comparative studies. Lodde et al [17] recently performed a systematic review of DP for femoral fractures.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medial and lateral dual plating of native distal femur fractures: a systematic literature review

O’Neill

Hakim

DeKeyser

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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Introduction:Lateral locked plating (LLP) development has improved outcomes for distal femur fractures. However, there is still a modest rate of nonunion in fractures treated with LLP alone, with higher nonunion risk in high-energy fractures, intra-articular involvement, poor bone quality, severe comminution, or bone loss. Several recent studies have demonstrated both the safety and the biomechanical advantage of dual medial and lateral plating (DP). The purpose of this study was to evaluate the clinical outcomes of DP for native distal femoral fractures by performing a systematic review of the literature.Methods:Studies reporting clinical outcomes for DP of native distal femur fractures were identified and systematically reviewed. Publications without full-text manuscripts, those solely involving periprosthetic fractures, or fractures other than distal femur fractures were excluded. Fracture type, mean follow-up, open versus closed fracture, number of bone grafting procedures, nonunion, reoperation rates, and complication data were collected. Methodologic study quality was assessed using the Coleman methodology score.Results:The initial electronic review and reverse inclusion protocol identified 1484 publications. After removal of duplicates and abstract review to exclude studies that did not discuss clinical treatment of femur fractures with dual plating, 101 potential manuscripts were identified and manually reviewed. After final review, 12 studies were included in this study. There were 199 fractures with average follow-up time of 13.72 months. Unplanned reoperations and nonunion occurred in 19 (8.5%) and 9 (4.5%) cases, respectively. The most frequently reported complications were superficial infection (n = 6, 3%) and deep infection (n = 5, 2.5%) postoperatively. Other complications included delayed union (n = 6, 3%) not requiring additional surgical treatment and knee stiffness in four patients (2%) necessitating manipulation under anesthesia or lysis of adhesions. The average Coleman score was 50.5 (range 13.5–72), suggesting that included studies were of moderate-to-poor quality.Conclusions:Clinical research interest in DP of distal femoral fractures has markedly increased in the past few decades. The current data suggest that DP of native distal femoral fractures is associated with favorable nonunion and reoperation rates compared with previously published rates associated with LLP alone. In the current review, DP of distal femoral fractures was associated with acceptable rates of complications and generally good functional outcomes. More high-quality, directly comparable research is necessary to validate the conclusions of this review.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medial and lateral dual plating of native distal femur fractures: a systematic literature review

O’Neill

Hakim

DeKeyser

et al. 2023

OTA International: The Open Access Journal of Orthopaedic Trauma

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“…Therefore, some scholars believe that it is more feasible to select double plates as a treatment for distal femoral fractures with medial cortical defects [17][18][19][20], as the placement of a medial plate improves the overall strength of the internal xation and strengthens resistance to deformation. However, the double plate still has defects, including large incision exposure during placement, resulting in prolonged operative time, increased bleeding, and di culty placing staples medially.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical study of the ortho⁃bridge system used in bilateral fixation of type A3 distal femoral fracture

liu¹,

qi²,

long³

et al. 2022

Preprint

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Background To compare the biomechanical parameters of AO/OTA type A3 distal femoral fractures fixed bilaterally with an ortho-bridge system (OBS) and lateral locking compression plate + locking reconstruction plate (LCP + LRP). Methods Twelve A3 distal femoral fracture models with medial cortical defects of the distal femur were created using synthetic femoral Sawbones. OBS and LCP + LRP were used for bilateral fixation, with six in each group. Axial compression and torsion tests were performed on the two groups of fracture models to determine their stiffness during axial compression and the torsion angles during torsion tests. Axial compression failure tests were performed to collect the vertical loads of the ultimate failure tests. Results In the test conducted on the fixed type A3 distal femoral fracture models, the axial stiffness in the OBS group (group A) (1072.61 ± 113.5 N) was not significantly different from that of the LCP + LRP group (group B) (1184.13 ± 110.24 N) (t = 1.726, P = 0.115), the torsion angle in the group B (2.6° ± 0.03°) was higher than that in group A (2.36° ± 0.1°) (t = 5.746, P < 0.001), and the ultimate failure test of type A3 fracture model showed that the vertical load to destroy group A fixation (5290.45 ± 109.63 N) was higher than that of the group B (3978.43 ± 17.1 N) (t = 23.28, P < 0.05). Notably, intertrochanteric fractures occurred in the A and B groups. Conclusions In the fixation of type A3 distal femoral fractures, the anti-axial compression of OBS was similar to that of the LCP + LRP group, but the anti-torsion was better.

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Short-term outcomes of periprosthetic compared to native distal femur fractures, a national database study

Upfill-Brown

Arshi

Sekimura

et al. 2021

Arch Orthop Trauma Surg

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Biomechanical and anatomical considerations for dual plating of distal femur fractures: a systematic literature review

Cited by 27 publications

References 46 publications

Medial and lateral dual plating of native distal femur fractures: a systematic literature review

Medial and lateral dual plating of native distal femur fractures: a systematic literature review

Biomechanical study of the ortho⁃bridge system used in bilateral fixation of type A3 distal femoral fracture

Short-term outcomes of periprosthetic compared to native distal femur fractures, a national database study

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