Distal Femoral Fixation: A Biomechanical Comparison of Trigen Retrograde Intramedullary (I.M.) Nail, Dynamic Condylar Screw (DCS), and Locking Compression Plate (LCP) Condylar Plate

Heiney, Jake P.; Barnett, Matthew; Vrabec, Gregory A.; Schoenfeld, Andrew J.; Baji, Avinash; Njus, Glen O.

doi:10.1097/ta.0b013e31815edeb8

Cited by 90 publications

(62 citation statements)

References 48 publications

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“…[13][14][15] It is of interest that cadaveric studies have consistently showed that regardless of fracture pattern, retrograde intramedullary fixation with distal locking screws has demonstrated the highest resistance to fatigue, failure and resistance to both axial and torsional forces when compared to fixed angle devices. [16][17][18][19] In the line with the above, Pekmezci et al 15 confirmed that the new locking retrograde femoral nail (with more distal screw fixation) displayed better stiffness and fatigue life than locking plates and the mode of failure for the plate was invariably plate fatigue. Another surgical option that could be considered in these distal femoral fractures with fragmentation is acute endoprosthetic replacement.…”

Section: Introductionmentioning

confidence: 62%

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

Atrey

Hussain²,

Gosling³

et al. 2017

Journal of Orthopaedics

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Introduction: Although the use of an endoprosthesis for distal femoral fractures remains a valid treatment option the widespread use is in its infancy. Methodology: In this retrospective case series, we review cases of distal femoral fracture treated with endoprosthetic replacement (EPR). The outcomes we assessed were the time to start mobilising, the time to discharge, morbidity and mortality as well as an Oxford knee score to assess pain and function and also the early survivorship. 6 of the 11 from the cohort had existing Total Knee Replacements (TKRs) in situ. Results: There were 11 knees in our cohort with a mean age of 81.5 years (range 52-102 years). The median time to follow up was 3.5 years (range 1.6 to 5.5 years). The median times to theatre was 3 days and to discharge was 16 days. Oxford functional and pain scores were 32/48. Discussion: In the appropriate patient and fracture pattern, Endoprosthetic knee replacement is an excellent option in the treatment of distal femoral fractures whether associated with an existing TKR or not. The implant is more costly than traditional open reduction and internal fixation, but the earlier return to full mobility post-operatively may save on hospital/care home stay and free up hospital space and minimise complications.

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Section: Introductionmentioning

confidence: 62%

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

Atrey

Hussain²,

Gosling³

et al. 2017

Journal of Orthopaedics

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“…5 However, in the recent years the results of internal fixation, even in the elderly patients, have generally been more favorable than conservative treatment with traction or cast bracing. 2,[6][7][8] Although distal femur replacing total knee replacement, angled blade plates, and other methods have been successfully used to treat distal femur fractures in the elderly patients, locked plating and intramedullary nailing remain the current standards of operative care. [9][10][11][12] Nevertheless, high rates of complications and mortalities continue to be reported in all methods of internal fixation for distal femur fractures in the elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

Shulman

Patsalos-Fox

Lopez

et al. 2014

Geriatr Orthop Surg Rehabil

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Background: The purpose of this study was to compare the functional outcomes and quality of life of older and younger patients with similarly treated distal femur fractures. Methods: We conducted an assessment of 57 patients who sustained distal femur fractures (Orthopaedic Trauma Association Type 33B, C) and underwent surgical treatment at our academic medical center. Patients were divided into 2 groups for analysis: an elderly cohort of patients aged 65 or older and a comparison cohort of patients younger than age of 65. A retrospective review of demographics, preoperative ambulatory status, radiographic data, and physical examination data was collected from the medical records. Follow-up functional data were collected via telephone at a mean of 2.5 years (range 6 months-8 years) using a Short Musculoskeletal Functional Assessment (SMFA). All patients underwent standard operative treatment of either nail or plate fixation. Results: There was no statistical difference in gender, fracture type, surgical technique, surgeon, or institution where the surgery was performed. The percentage of patients with healed fractures at 6-months follow-up was not significantly different between the cohorts. The elderly cohort had slightly worse knee range of motion at 3, 6, and 12 months postoperatively but there was not a statistically significant difference between the groups. The SMFA Daily Activity, Functional, and Bother indices were significantly worse in the older cohort (P < .01, P ¼ .01, P ¼ .02, respectively). However, there was no significant difference in the SMFA Emotional or Mobility indices. Conclusion: Despite lower quality of life and functional scores, this study suggests that relatively good clinical outcomes can be achieved with surgical fixation of distal femoral fractures in the elderly patients. Age should not be used as a determinate in deciding against operative treatment of distal femur fractures in the elderly patients.

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“…Distal femoral fractures continue to be a challenge for orthopedic surgeons. A number of treatment modalities for distal femur fractures have been reported in the literature, including dynamic condylar screw-plate (DCSPlates) (1)(2)(3)(4). Although many anatomic, morphologic, and radiologic studies have been carried out for femurs, as for all other bones of the skeletal system, we could not find any morphometric study useful for orthopedic surgeons wishing to understand DCS-Plate effects on the distal femur (5)(6)(7).…”

Section: Introductionmentioning

confidence: 38%

Do dynamic condylar screw-plates lead to iatrogenic fracture?

Aytekin¹,

Küçükdurmaz²,

Çeli̇k³

et al. 2013

Turk J Med Sci

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Th e Karadere segment of the North Anatolian Fault (NAF) is the easternmost part that ruptured during the 17 August 1999 İzmit earthquake (Mw 7.4). It has a diff erent orientation, at N65°E to other segments which have a nearly E-W trend, and lesser dextral displacement, with maximum 2.3 m in contrast with 5.2 m in the ruptured neighbouring western segment. Two palaeoseismological trenches, at Kazimiye and Karadere sites, were excavated on the central part of the Karadere segment to determine the timing of past earthquakes.Excavation of the Kazimiye site revealed the occurrence of fi ve past events since the 4 th century A.D., including the 1999 İzmit earthquake. Th e oldest event occurred aft er A.D. 231-407 and before A.D. 420-584 based on 14 C dating results. Th is event may correspond to either the A.D. 358 earthquake or the A.D. 554 historical earthquake. Th e younger three events predate 1999 and postdate A.D. 420-584. At the Karadere trench site, three past events, including the 1999 İzmit earthquake, were identifi ed. Th e penultimate event was observed on the trench wall and dated to be aft er A.D. 1298-1370. Th e older event is dated as before A.D. 1150-1261, which may correspond to one of the determined events in the Kazimiye trench. In summary, palaeoseismological data provide evidence for at least fi ve large earthquakes on the Karadere segment since A.D. 231-407, including the 1999 İzmit earthquake.

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Distal Femoral Fixation: A Biomechanical Comparison of Trigen Retrograde Intramedullary (I.M.) Nail, Dynamic Condylar Screw (DCS), and Locking Compression Plate (LCP) Condylar Plate

Cited by 90 publications

References 48 publications

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

Do Elderly Patients Fare Worse Following Operative Treatment of Distal Femur Fractures Using Modern Techniques?

Do dynamic condylar screw-plates lead to iatrogenic fracture?

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