Locking plate fixation versus antegrade intramedullary nailing for the treatment of extra-articular distal femoral fractures

Öçalan, Enes; Ustun, C.C.; Aktuğlu, Kemal

doi:10.1016/j.injury.2019.07.008

Cited by 8 publications

(9 citation statements)

References 66 publications

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“…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.…”

Section: Resultsmentioning

confidence: 99%

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Wang,

Stockton,

Flury

et al. 2024

JBJS Reviews

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Background: Distal femur fractures are known to have challenging nonunion rates. Despite various available treatment methods aimed to improve union, optimal interventions are yet to be determined. Importantly, there remains no standard agreement on what defines radiographic union. Although various proposed criteria of defining radiographic union exist in the literature, there is no clear consensus on which criteria provide the most precise measurement. The use of inconsistent measures of fracture healing between studies can be problematic and limits their generalizability. Therefore, this systematic review aims to identify how fracture union is defined based on radiographic parameters for surgically treated distal femur fractures in current literature. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, Medline, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection databases were searched from inception to October 2022. Studies that addressed surgically treated distal femur fractures with reported radiographic union assessment were included. Outcomes extracted included radiographic definition of union; any testing of validity, reliability, or responsiveness; reported union rate; reported time to fracture union; and any functional outcomes correlated with radiographic union. Results: Sixty articles with 3,050 operatively treated distal femur fractures were included. Operative interventions included lateral locked plate (42 studies), intramedullary nail (15 studies), dynamic condylar screw or blade plate (7 studies), dual plate or plate and nail construct (5 studies), distal anterior-posterior/posterior-anterior screws (1 study), and external fixation with a circular frame (1 study). The range of mean follow-up time reported was 4.3 to 44 months. The most common definitions of fracture union included “bridging or callus formation across 3 of 4 cortices” in 26 (43%) studies, “bony bridging of cortices” in 21 (35%) studies, and “complete bridging of cortices” in 9 (15%) studies. Two studies included additional assessment of radiographic union using the Radiographic Union Scale in Tibial fracture (RUST) or modified Radiographic Union Scale in Tibial fracture (mRUST) scores. One study included description of validity, and the other study included reliability testing. The reported mean union rate of distal femur fractures was 89% (range 58%-100%). The mean time to fracture union was documented in 49 studies and found to be 18 weeks (range 12-36 weeks) in 2,441 cases. No studies reported correlations between functional outcomes and radiographic parameters. Conclusion: The current literature evaluating surgically treated distal femur fractures lacks consistent definition of radiographic fracture union, and the appropriate time point to make this judgement is unclear. To advance surgical optimization, it is necessary that future research uses validated, reliable, and continuous measures of radiographic bone healing and correlation with functional outcomes. Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Resultsmentioning

confidence: 99%

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Wang,

Stockton,

Flury

et al. 2024

JBJS Reviews

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“…All but one of these studies [ 19 ] includes functional scores, ranging from assessment of range of motion, to the KOOS [ 22 ] or Lysholm Score [ 23 ]. The functional scores between the two techniques have been largely equivocal, with only two studies [ 24 ] [ 18 ] concluding that function in the IMN group was statically significantly superior.…”

Section: Discussionmentioning

confidence: 99%

“…(Functional score–Sanders criteria) Meneghini [ 19 ] 2014 91 6–176 Locking plate v retrograde IMN The rate of non-unions in the IM nail group was 9% compared to 19% non-union/delayed unions in the LP group No functional score Park [ 20 ] 2016 41 24–66 Locking plate v retrograde IMN IMN group had a higher rate of malunion, no statistical difference between the clinical outcomes of both groups Gill [ 17 ] 2017 42 3–16 Locking plate v retrograde IMN IMN produced greater operative time and blood loss. The functional and union time between the two groups was not statistically significant different Ocalan [ 24 ] 2019 97 41–130 Locking plate v antegrade IMN Antegrade IMN achieved significantly better functional outcomes and less non-unions. (Functional score –lysholm) …”

Section: Introductionmentioning

confidence: 99%

Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients

Howard,

Myatt,

Hodgson

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose The aim of this study was to evaluate the results of distal femoral fracture fixation of two different methods, lateral locking plate (LP) or an Intra-medullary nail (IMN), in patients managed in our institution. More specifically, to assess: (a) if there was a difference in functional outcomes between the LP and IMN groups; (b) whether the rate of complications was different between the two groups. Methods Between January 2009 and December 2018 adult patients with distal femoral fractures managed in our unit with either LP or IMN for extra and intra-articular fractures were eligible to participate. Demographic details, fracture type, procedures performed, time to union, complications and functional scores (Oxford Knee Score) were recorded and analysed. The mean follow up was 4 years (12–120 months). Results Out of 193 patients who met the inclusion criteria, 93 received an IMN whereas 100 patients were treated with LP. Mean age was 64.2 (18–99) and 70.1 (18–100) for the IMN and LP groups respectively. Overall, the two groups had similar demographics and there was no significant difference in the type of fractures sustained (p > 0.05). The Oxford Knee Score was highest for patients fixed with LP, mean 37.3 (6–48, SD 7.3) versus 28.4 (3–48, SD 14.4), (p = < 0.02) compared to the IMN group. In terms of complications, the rate of non-union was higher in the LP group 8.6% versus 4% in those patients treated with an IMN, p value < 0.01. Conclusion While the rate of non-union was higher in the LP group and the functional results were superior in the plating group.

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“…The option of internal fixation was based on factors such as fractures' state, comorbidity, and skin condition. Theoretically, a locking plate has a potential advantage in osteoporotic bone, provides sufficient strength to resist pullout, and this fixation allows screws to improve the stability of construction and facilitate bridging fixation, helping to maintain the reduced calcaneus morphology (29,30). In particular, the locking plate is fit for Sanders type II and III fractures (31).…”

Section: Discussionmentioning

confidence: 99%

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

Huang¹,

Guo²,

Zhu³

2021

Ann Palliat Med

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Background: To analyze the epidemiology and features of calcaneus osteomyelitis following open reduction and internal fixation (ORIF) after closed calcaneus fracture.Methods: We retrospectively analyzed 127 cases who were diagnosed with calcaneal osteomyelitis following ORIF via the extended lateral "L-shaped" approach after closed calcaneus fracture between March 2016 and August 2019 in our hospital. We analyzed participant demographics including gender, age, body mass index (BMI), trauma mechanism, Sanders classification, co-morbidity, time between initial injury and surgery, operating time, soft tissue stripping tools, tourniquet pressure, bone grafting option, internal fixation option, presence of bleeding after tourniquet deflation, and drainage option.Results: The majority of cases (n=127) were male (4.5 times more than female gender), at a ratio of 4.47:1.Falling from height was the main trauma mechanism (79.53%), followed by traffic accident (14.17%), and jumping (6.3%). A total of 51 cases (40.16%) were left-side fractures, and 76 (59.84%) were right-sided.According to the Sanders classification, 12 cases were type II (9.45%), 61 cases were type III (48.03%), and 54 cases were type IV (42.52%). There were 25 participants with the co-morbidity of type 2 diabetes mellitus (19.69%), 7 with hypertension (5.51%), and 1 case each of psoriasis and sicca syndrome (0.8%). The mean time to surgery was 4.7 days (4-9 days), and 123 participants (96.85%) were treated within 7 days. The mean operating time was 102.1 min (75-135 min). Forty-four participants (34.65%) received the conventional scalpel and 83 participants (65.35%) the electric scalpel during soft tissue stripping intraoperatively. The mean tourniquet pressure was 432.3 mmHg (350-550 mmHg). Autologous bone grafting was observed in 6 cases (4.72%), allograft bone grafting in 11 cases (8.67%), and OsteoSet grafting in 7 cases (5.51%).A locking plate was used in 114 cases (89.76) while anatomical plate in 13 cases (10.24%). A total of 27 participants (21.26%) bled after tourniquet deflation. Drainage tubes were applied in 30 participants (23.62%) while rubber drainage strips in 5 participants (3.94%).Conclusions: Young males dominated the calcaneus osteomyelitis following traumatic calcaneus fracture cohort in this study. A fall from height was the most frequent trauma mechanism. The presence of severe calcaneus fracture, Sanders type III (48.03%) and type IV (42.52%), were the common fracture types in this population group.

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Locking plate fixation versus antegrade intramedullary nailing for the treatment of extra-articular distal femoral fractures

Cited by 8 publications

References 66 publications

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Radiographic Union Assessment in Surgically Treated Distal Femur Fractures

Retrograde intramedullary nailing or locked plating for stabilisation of distal femoral fractures? A comparative study of 193 patients

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

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