Fractures of the distal femur in elderly patients: retrospective analysis of a case series treated with single or double plate

Abstract

Introduction We evaluated the radiologic and clinical outcomes of a lateral incision single plate with and a single-incision double plating in elderly patients with osteoporotic distal femoral fractures. Materials and methods We performed a retrospective study of 82 cases of distal femoral fractures from May 2004 to June 2018. Group A consisted of 42 patients who underwent single-plate fixation. Group B consisted of 40 patients who underwent double-plate fixation. The mean patient age was 77 years (67–87 years) and 76 years (64–86 years) in groups A and B, respectively. All patients were evaluated for procedure duration, time to union, range of knee motion, Lysholm knee score, and presence of complications. Results The average procedure time was 81 min (66–92 min) and 110 min (95–120 min) in groups A and B, respectively (p = 0.33). One case in group B required bone grafting after 5 months. The average time to union was 14 weeks (9–19 weeks) and 12.2 weeks (8–19 weeks) (p = 0.63), and the mean range of knee motion was 105° (90–125°) and 110.7° (90°–130°) (p = 0.37) in groups A and B, respectively. There was no significant statistical difference between the two groups in the Lysholm knee score (p = 0.44) and knee society score (p = 0.53). Conclusion The clinical and radiological outcomes were similar in the 2 groups. In elderly patients, double plate fixation for distal femoral fractures is an useful method for several advantages such as adequate exposure, easy manipulation, anatomical reduction and stable fixation.

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

“…By contrast, Wang et al found a score of 9 out of 12 on the RUST, consistent with bridging across 3 of 4 cortices, to be healed 68 . Nam et al also found fractures to be healed with mRUST scores ranging from 6 to 14 out of 16 55 . However, neither of these 2 studies reported testing of reliability of the scoring.…”

“…Wang et al reported radiographic union scoring at 1, 3, 6, and 12 months postoperatively, defining final union as bridging callus present in 3 of 4 cortices, which translated to a score of at least 9 of 12 on the RUST scale 68 . Nam et al assessed radiographs at 3, 6, 12, 24 weeks, and 1 year after distal femur fractures treated with either single plate or dual plate 55 . The authors determined bony union to be achieved “when callus was sufficiently formed, and the trabeculae were connected through the fracture line” 55 .…”

“…Sixty articles met the inclusion criteria 3,17–75 (Table I). The included articles were from 37 different journals, had 58 different first authors, and were published between 1990 and 2022.…”

“…Nam et al assessed radiographs at 3, 6, 12, 24 weeks, and 1 year after distal femur fractures treated with either single plate or dual plate 55 . The authors determined bony union to be achieved “when callus was sufficiently formed, and the trabeculae were connected through the fracture line” 55 . In addition, the mRUST score was used at the time union was defined; scores of 9.8 (6-14) and 10.4 (7-14) out of 16 were found for fractures treated with single-plate and dual plate constructs, respectively 55 .…”

Geriatric distal femoral fractures: post-operative complications and nine-year mortality—a retrospective analysis of two tertiary trauma centres

“…Therefore, emphasis should be placed on stable constructs such as a double plate, with reported high union rates and acceptable ranges of motion in both native DFFs and periprosthetic fractures compared with one lateral plate stabilization; also, double plate allows early complete weightbearing [ 30 , 31 ], which is critical in the treatment of elderly fractures proposed by Kammerlander et al [ 32 ]. A meta-analysis carried out by Koso et al [ 33 ] reported higher rates of non-union in distal femur fractures, which is why there are case series that recommend the use of fibula autografts with double plates to reduce the possibility of non-unions [ 34 ].…”