Double fixation for complex distal femoral fractures

Stoffel, Karl; Sommer, Christoph; Lee, Mark; Zhu, Tracy Y.; Schwieger, Karsten; Finkemeier, Christopher G.

doi:10.1530/eor-21-0113

Cited by 18 publications

(8 citation statements)

References 53 publications

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“…Popular options of double fixation of a comminuted distal femur fracture include a dual plating construct or a nail-and-plate construct [ 13 , 14 ]. Stoffel reviewed multiple studies in 2022 [ 15 ]. Although there was no statistical analysis, he concluded that both constructs gave high union rates and satisfactory functional outcomes; choosing which constructs to use relied on balancing the pros and cons with each other.…”

Section: Discussionmentioning

confidence: 99%

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

Leung,

Fang,

Yung

et al. 2024

BMC Musculoskelet Disord

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Background The aim of this study is to determine the best plate to use as a substitute to fix a medial femoral condyle fracture. Materials and methods The first part is to measure the best fit between several anatomical plates including the Proximal Tibia Anterolateral Plate (PT AL LCP), the Proximal Tibia Medial Plate (PT M LCP), the Distal Tibia Medial Locking Plate (DT M LCP) and the Proximal Humerus (PHILOS) plate against 28 freshly embalmed cadaveric distal femurs. Measurements such as plate offset and number of screws in the condyle and shaft shall be obtained. The subsequent part is to determine the compressive force at which the plate fails. After creating an iatrogenic medial condyle fracture, the cadavers will be fixed with the two plates with the best anatomical fit and subjected to a compression force using a hydraulic press. Results The PT AL LCP offered the best anatomical fit whereas the PHILOS plate offered the maximal number of screws inserted. The force required to create 2 mm of fracture displacement between the two is not statistically significant (LCP 889 N, PHILOS 947 N, p = 0.39). The PT AL LCP can withstand a larger fracture displacement than the PHILOS (LCP 24.4 mm, PHILOS 17.4 mm, p = 0.004). Discussion and conclusion Both the PT AL LCP and the PHILOS remain good options in fixing a medial femoral condyle fracture. Between the two, we would recommend the PT AL LCP as the slightly superior option.

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Section: Discussionmentioning

confidence: 99%

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

Leung,

Fang,

Yung

et al. 2024

BMC Musculoskelet Disord

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“…Stoffel et al have suggested placing oblique screws at the ends of the plates to enhance fixation strength. [ 36 ] We prefer using as many locking screws as possible in the distal fragment and bending the proximal end screw.…”

Section: Discussionmentioning

confidence: 99%

Comparison of radiological and functional results in osteoporotic distal femur fractures operated with single plating, lateral incision, and double plating, anterior paramedial incision: A retrospective study

Çalbiyik,

Zehir,

Demirezen

2024

Medicine

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Treatment of osteoporotic distal femur fractures is often complicated by a high rate of nonunion and varus collapse. For such fractures, lateral plating with lateral incision and double plating with anterior paramedial incision have shown promising results in the recent literature. The hypothesis of this study was that bilateral plating of comminuted distal femur fractures in osteoporotic patients would result in higher union rates and lower revision rates compared to an isolated lateral locking plate. The study included 56 patients (23 males, 33 females) with supracondylar femur fracture. According to the OA/OTA classification, 9 were type A3, 8 were A2, 13 were C1, 16 were C2, and 10 were C3. The mean follow-up period was 12 months, with 29 patients treated using lateral mini-incision, lateral locking plate, and 27 patients treated with anterior paramedial incision, dual plating. The clinical and radiological results were evaluated. The mean duration of radiological union in the studied population was 15 ± 2.1 months (range, 11–21 months) in the single plate group (Group A), and 13.5 ± 2.6 months (range, 9–19 months) in the double plate group (Group B). Mean ROM was 112.3° and flexion contracture 4° in Group A, and ROM 108.3° and flexion contracture 6.7° in Group B. (P = .15). The average Western Ontario and McMaster Universities Arthritis Index (WOMAC) score was 85.6 points in Group A and 83.5 points in Group B (P = .2278). The postoperative anteversion measurement in the operated extremity ranged from −15 to 19 in Group A, and from 5 to 18 in Group B. When the anteversion degrees were compared between the injured and uninjured extremities in the postoperative period, a significant difference was observed within Group A (P = .0018), but no significant difference was observed in Group B (P = .2492). Dual plate fixation using the anterior paramedial approach is an effective operative method for osteoporotic distal femur fractures. This has many advantages such as precise exposure, easy manipulation, anatomic reduction, and stable fixation. However, for surgical indications and medial bone defects > 1 cm, grafting should be performed.

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“…Also, Ruchholtz et al , Ehlinger et al and Wood et al concluded that minimally invasive techniques should be the preferred treatment for PPFFs fixation ( 28 , 29 , 30 ). Kanakaris et al and Wood et al discussed that despite the potential advantage of smaller less invasive procedures with less blood loss and improved fracture biology, this should not be at the expense of a malreduced fracture ( 24 , 30 ).There is clear data that adequate fracture reduction and femoral axis alignment, avoiding varus deformity, are crucial to prevent delayed union or mechanical complications ( 31 , 32 , 33 ). All delegates agreed that open reduction should be considered, when necessary, to avoid malreduction.…”

Section: Discussionmentioning

confidence: 99%

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators’ recommendations

Castillón,

Muñoz Vives,

Aguado

et al. 2024

EFORT Open Reviews

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A peri-implant femoral fracture (PIFF) is defined as a femoral fracture in the presence of a pre-existing non-prosthetic implant. Classification systems, treatment guidelines and fixation strategies exist for peri-prosthetic fractures, but there is no standard of care regarding PIFFs. The aim of the Peri-Implant Spanish Consensus (aka PISCO) investigators is to reach an agreement regarding current practices for management of PIFFs and to propose four main principles to assess surgical treatment and prevention of these fractures. This consensus review was conducted according to the Delphi method. Twenty-two expert orthopaedic trauma surgeons performed the consensus and the definitive statements were approved unanimously. Biological fixation principles must be utilized in the surgical treatment of peri-implant femur fractures, which include closed or minimally invasive reduction techniques. The osteosynthesis must protect the entire bone. Gaps between two implants should be avoided. If implant overlap is not possible to achieve, then spanning inter-implant fixation systems must be used, especially in osteoporotic bone. Previous implants should be retained during surgical treatment of peri-implant femur fractures. Only those implants that would interfere with current fixation goals should be removed. If the previous implant is in the femoral neck region, then femoral neck protection must be maintained when treating the peri-implant fracture, even if the neck fracture has already healed.

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Double fixation for complex distal femoral fractures

Cited by 18 publications

References 53 publications

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

Determination of the ideal plate for medial femoral condyle fracture fixation: an anatomical fit and biomechanical study

Comparison of radiological and functional results in osteoporotic distal femur fractures operated with single plating, lateral incision, and double plating, anterior paramedial incision: A retrospective study

Consensus review on peri-implant femur fracture treatment: Peri-Implant Spanish Consensus (PISCO) investigators’ recommendations

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