Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis

Trıpathy, Sujit Kumar; Mishra, Narayan Prasad; Varghese, Paulson; Panigrahi, Sibasish; Purudappa, Prabhudev Prasad; Goel, Akshay; Sen, Ramesh Kumar

doi:10.1007/s43465-021-00489-0

Cited by 21 publications

(13 citation statements)

References 34 publications

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“…Dual plating of distal femur fractures has gained more attention for preventing varus collapse and implant failure in comminuted metaphyseal and articular fractures. In a systematic review, satisfactory results were found for comminuted metaphyseal and articular fractures following dual plating, but no differences were found between single lateral plating and dual plating with regards to non-union rate, blood loss, functional outcomes, and complications, although dual plating led to faster fracture healing [ 23 ]. A large cohort series of 335 cases reviewed risk factors for failure of locked plate fixation in distal femur fractures and identified the following risk factors for reoperation to promote union and complications: open fracture, diabetes, smoking, increased body mass index, and shorter plate length [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome Evaluation of Distal Femoral Fractures Following Surgical Management: A Retrospective Cohort Study

Neumann

Sontheimer

Borchert³

et al. 2023

JPM

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Background: Distal femur fractures are challenging in surgical management as the outcome is crucial for restoring the biomechanical stability and longitudinal axis of the leg and function of the knee joint. Methods: A retrospective review of all distal femoral fractures treated in a level I trauma center over a decade was performed. The radiographs were reviewed for fracture entity, osseous healing, implant failure, mechanical axis, and degenerative joint changes. Clinical outcome was reviewed regarding postoperative complications and postoperative range of motion of the knee joint. Results: 130 patients who were managed with screw fixation (n = 35), plating systems (n = 92) or intramedullary nailing systems (n = 3) remained for evaluation. Mean follow up was 26 months. Clinical outcome was significantly better for flexion degrees following screw fixation (p = 0.009). Delayed fracture union (p = 0.002) or non-union (p = 0.006) rates were significantly higher in plate osteosynthesis. Mild pathologic deformity for varus and valgus collapse was found following plate osteosynthesis. Conclusions: Screw fixation shows fewer postoperative complications than plate fixation and is favored for extra and partial intraarticular distal femur fractures. Plating constructs remain the superior fixation method in complex distal femur fractures but are associated with higher rates of non-union and leg axis deviation.

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Section: Discussionmentioning

confidence: 99%

Outcome Evaluation of Distal Femoral Fractures Following Surgical Management: A Retrospective Cohort Study

Neumann

Sontheimer

Borchert³

et al. 2023

JPM

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“…Dual plating was proven by several investigators to provide superior stability by decreasing the lever arm acting on femoral axis thus lowering applied load on the fracture [21][22][23]. Also, stabilizing both columns and providing a stronger fixation in osteoporotic comminuted distal femur fractures [24]. In a recent biomechanical study, artificial femora simulating osteoporotic bone with fixed distal femoral fractures were subjected to axial, torsional, and quasistatic loading, and dual plating showed significantly lesser longitudinal and shear displacement than single plating [25].…”

Section: Discussionmentioning

confidence: 99%

Primary fibular grafting combined with double plating in distal femur fractures in elderly patients

Ibrahim

Ghazawy

Hussien

2022

International Orthopaedics (SICOT)

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Purpose To report functional and radiological outcomes of using primary fibular graft together with double plating in distal femoral fractures in the elderly. Methods A retrospective study on 30 elderly patients with comminuted distal femoral fractures managed by primary fibular grafting and double plating through an anterior midline approach has been conducted. Only isolated distal femoral fractures type 33-A3, 33-C2, and 33-C3 were included. The patient’s mean age was 75.3 years. Evaluation included operative time, blood loss, time to union, knee range of motion, Sanders scoring, and presence of complications. Results The average follow-up period was 26.6 months. Mean intraoperative blood loss was 401 ml, and mean operative time was 216 min. All patients had a knee range of motion (90–120°) during follow-up. Time for union ranged from 16 to 23 weeks with a mean of 18.4 weeks, with no cases of non-union. A total of 22 patients (73.3%) showed excellent functional outcomes, and the remaining eight (26.7%) showed good functional outcomes according to the Sanders scoring system. Only two cases (6.6%) had superficial wound infections managed conservatively. No post-operative deformity, loss of reduction, or implant failure was observed until the end of follow-up period. Conclusion Primary fibular grafting combined with double plating of comminuted distal femur fractures in patients above 70 years is an effective technique with higher rates of union and lower re-operation rates compared to other fixation modalities.

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“…7 Dual plate xation has been heralded as an alternative xation technique, however non-union and delayed union rates reach 12.5% and 33.3% respectively. 12 The nail-plate construct is a more recently described method for distal femur fractures, combining LP and IMN to provide biomechanically advantageous xation. This construct has the potential to reduce the risk of non-and mal-union and allows patients to mobilise immediately post-operatively without weightbearing restrictions.…”

Section: Introductionmentioning

confidence: 99%

Best of Both Worlds? Fixation of Distal Femur Fractures with the Nail-Plate Construct. Patient-Reported Outcomes and One-Year Results in a Heterogenous Population

Pfister

Wilson

Drobetz

2023

Preprint

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Objectives Distal femoral fractures are a significant injury sustained by low- and high-energy trauma. Common treatment practices are lateral locking plate or intramedullary nail fixation, with disadvantages including risk of non- and mal-union and limited post-operative weightbearing status. Combining both techniques as a nail-plate construct (NPC) theoretically achieves enhanced fixation to allow immediate weightbearing. This study examines the functional, radiographic, and patient-reported outcomes of distal femur NPC fixation. Methods Single-centre combined prospective and retrospective study including all patients > 18 years who sustained distal femur fractures treated with NPC. The primary outcome was radiographic union and malunion at minimum one-year follow-up. Secondary outcome measures included patient reported outcome measures, post-operative mobility, length of stay and complications. Results Sixteen patients were included in the study. Rate of radiographic union was 100%. There was no case of malunion. All patients were allowed to full weight bear immediately post-operatively. Mean length of stay was 9.50 days, with 37.5% of patients discharged directly home. The majority (85.7%) of patients returned to pre-injury mobility. Early post-operative complications occurred in three patients. Three patients returned to theatre. The mean EQ-5D-5L index value was 0.713, with 71.4% describing no problems with self-care and 85.7% reporting no or slight problems with usual daily activities. Conclusions The NPC provided stable fixation permitting full weightbearing post-operatively with no cases of non- or malunion. Return to pre-injury mobility and activity are encouraging. Based on these results we support the use of nail-plate construct fixation in the management of distal femur fractures.

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Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis

Cited by 21 publications

References 34 publications

Outcome Evaluation of Distal Femoral Fractures Following Surgical Management: A Retrospective Cohort Study

Outcome Evaluation of Distal Femoral Fractures Following Surgical Management: A Retrospective Cohort Study

Primary fibular grafting combined with double plating in distal femur fractures in elderly patients

Best of Both Worlds? Fixation of Distal Femur Fractures with the Nail-Plate Construct. Patient-Reported Outcomes and One-Year Results in a Heterogenous Population

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