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

Abstract

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.

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 ].…”