Dual Plating of the Distal Femur: Indications and Surgical Techniques

Sain, Arnab; Vp, Sharma; Farooque, Kamran; Muthukumaran,; Pattabiraman, Kirubakaran

doi:10.7759/cureus.6483

Cited by 26 publications

(15 citation statements)

References 21 publications

(34 reference statements)

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“…Anatomically precontoured built reduces soft tissue problems and acts as internal external fixator. 8 In addition, a locking compression plate has got distinct advantages of unicortical fixation and least chance of plate back out as the screw gets locked to the plate. Further, minimal soft tissue injury occurs when closed reduction is done and MIPO technique is used.…”

Section: Introductionmentioning

confidence: 99%

Management of Distal Femoral fractures with Locking Compression Plate- A Prospective study

Kadam¹,

Mahadik²,

Rampure³

et al. 2021

Asian J Med Sci

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Background: Distal femoral fractures are one of the common type of fractures seen after motor vehicular accidents. The optimal management of these fractures requires open reduction and internal fixation by plates and screws. Various studies have shown that open reduction and internal fixation by plates and screws result in early post-operative knee mobilization which is essential for good union and better functional outcome. Aims and Objective: The current study was conducted to evaluate the results of fracture lower end of femur treated by open reduction and internal fixation using locking compression plate. Materials and Methods: This was a prospective clinical study in which the cases with fracture lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Fractures were categorised by Mullers classification. All patients were treated by distal femoral locking compression plates and screws. The cases were followed up for radiological union and functional outcome (Neer’s scoring). The statistical analysis was done using SSPS 21.0 software. P value less than 0.05 was taken as statistically significant. Results: Out of the 20 studied cases there were 13 (65%) males and 7 (35%) females with a M:F ratio of 1:0.53. Road traffic accidents were the most common cause (75%) of distal femoral fractures. The most common type of fracture seen in studied cases was found to be Mullers C2 type of fracture (45%) followed by Mullers C3 (20%) and Mullers C1 (15%). All patients were treated by open reduction and internal fixation. Mean Injury to surgery interval was found to be 4.25 days in studied cases. Postoperatively desirable knee flexion (1100) was achieved in 10 (50%) cases whereas in 8 patients 910-1090knee flexion was achieved. In 2 (10%) patients less than 900 knee flexion could be achieved. The functional outcome (as assessed by Neer’s score) showed that Good and fair results were seen in 13 (65 %) and 6 (30 %) patients. Poor functional outcome was seen in only 1 (5 %) patient. Conclusion: Locking compression plate is found to have good results in patients with traumatic distal femoral fractures in terms of early mobilization and functional outcome. Particularly in intra-articular fractures it provides good angular stability by its triangular reconstruction principle.

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Section: Introductionmentioning

confidence: 99%

Management of Distal Femoral fractures with Locking Compression Plate- A Prospective study

Kadam¹,

Mahadik²,

Rampure³

et al. 2021

Asian J Med Sci

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show abstract

“…Historically, from the 1960s, onward distal femur fractures were treated conservatively with fracture bracing and traction with success rates up to 67-90% [ 8 ]. Only with the development new surgical techniques and technologies the approach has shifted from conservative to surgical stabilization.…”

Section: Discussionmentioning

confidence: 99%

Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options

Starčević

Karačić

2021

Case Reports in Orthopedics

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The management of infected nonunion associated with bone loss in long bones is both a time-consuming and challenging procedure for the orthopedic and trauma surgeon. In this paper, we present the case of a 75-year-old woman with infected nonunion of the distal femur associated with bone loss after plate osteosynthesis for a distal femur fracture. The patient was referred for nonunion of the distal femur after plate fixation (nonlocking “classic” plate) and was treated with a locking compression plate (LCP) and autologous cancellous bone transplant. During the follow-up, the patient was ambulatory without pain; however, the nonunion failed to heal, therefore, the induced membrane technique (Masquelet procedure) was performed in two stages, tissue samples were taken and revealed a bacterial infection (S. epidermidis), and antibiotic treatment was started. Due to infection, fracture healing was slowed, but did commence. Unfortunately, the LC plate failed before union occurred, the nonunion was treated with a femoral nail and blocking (Poller) screws, and the bony defect was filled with Ca-P cement. The patient was operated one last time for cement dislocation when not only the dislocated cement was removed but also the femoral nail dynamized. After one year after treatment completion, the fracture healed, and leg length discrepancy was 1.5 cm shorter on the left side. The patient experienced significant pain relief and can walk with the help of crutches. Our paper demonstrates the application of different techniques in fracture surgery as they are required can result in fracture healing even in very adverse circumstances.

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“…Dual plating of the distal femur is believed to have a lower failure rate than single lateral plating as it eliminates cantilever bending by stabilising both sides of the distal femur. They also provide greater hold in the distal metaphysis particularly in osteoporotic bone 9 10…”

Section: Discussionmentioning

confidence: 99%

Failure of dual plating in a complex open distal femur fracture as the result of major trauma

2021

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A 61-year-old polytrauma patient was admitted with a right distal comminuted metaphyseal femoral fracture with intra-articular extension (Orthopaedic Trauma Association 33C2.3 classification) among other injuries. Due to the high degree of comminution and massive bone loss, this was initially managed with a dual plating open reduction internal fixation. Dual plating has shown to be a superior fixation method than single variable angle locking compression plate (VA-LCP) plating providing greater fixation in metaphyseal bone. Our case reports the failure of dual plating which required removal of metalwork and subsequent fixation using intramedullary nail and plate technique. Failure of dual plating is not well documented in the literature. The most recent radiographs taken 15 months postrevision surgery show that the bone has started to heal with evidence of callus formation.

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Dual Plating of the Distal Femur: Indications and Surgical Techniques

Cited by 26 publications

References 21 publications

Management of Distal Femoral fractures with Locking Compression Plate- A Prospective study

Management of Distal Femoral fractures with Locking Compression Plate- A Prospective study

Infected Nonunion of the Distal Femur in the Elderly with Bone Loss: Case Report and Treatment Options

Failure of dual plating in a complex open distal femur fracture as the result of major trauma

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