Technical Trick: Dual Plate Fixation of Periprosthetic Distal Femur Fractures

Abstract

Summary: Treatment of periprosthetic distal femur fractures remains challenging due to assuring adequate distal fixation. Traditional treatment options include lateral locked plating and retrograde nailing, although recently dual implant constructs have been explored with promising results. Allowing immediate weight-bearing in this patient population has benefits with regards to rehabilitation and outcome. Recent literature has focused on nail–plate constructs, however plate–plate constructs are preferred at our institution as they do not require arthroplasty component compatibility, facilitate the coronal plane reduction, and allow for immediate weight-bearing.

Technical Trick: Supplemental Medial Column Screw Fixation of Distal Femur Fractures Treated With a Laterally Based Locked Plate

“…The union rates and complication profile of the supplemental medial column screw are comparable to other proposed strategies for supplemental medial fixation. 3,18,21,29,30 In closed fractures, we found no cases of nonunion. We do report 2 instances of nonunion, both of which occurred in open fractures, suggesting that the additional soft tissue injury or bone loss, which occurs with open fractures, may require more robust fixation than this construct provides.…”

“…Medial plate augmentation is gaining support, and biomechanical studies have shown improved stability of these dual implant constructs. 27,28 Although clinical case series remain small, 18,21 these limited dual plate series have shown low wound complications rates and improved union rates, however, with added surgical time and implant cost, which must factor into surgical decision making. Another construct that has been advocated for is the “nail plate combination,” which also demonstrates good union rates in case series, albeit with significant added implant cost.…”

“…Literature supported techniques include the addition of either a medial plate or an intramedullary nail to create a more biomechanically stable construct that improves nonunion rates and prevents varus collapse. 3,[19][20][21][22][23] Although these strategies are successful in many scenarios, these additional augments increase costs, adds to surgical complexity, and typically require a larger dissection or second surgical approach, which may increase morbidity in a highrisk population. 13,24,25 In this article, we report our institution's experience with supplemental, percutaneous, medial column screw fixation for supracondylar distal femur fractures managed with lateral locked plating.…”

Maintaining the Neutral Axis in the Treatment of Distal Femur Fractures Via Dual Plate or Nail Plate Combination Technique: When and How?

“…With a stable implant with a closed-box design, combined with medial comminution, the patient was indicated for DP technique. 7 The patient was positioned in a supine position on a radiolucent table. A small distal lateral incision was made centered over and at the level of the total knee prosthesis.…”

“…Here, additional fixation, via dual plate (DP) or nail plate combination (NPC) technique may offer a better biomechanical advantage to allow for immediate weight bearing and reduced risk of fixation failure. [5][6][7] Salas et al, performed a 2-part finite element analysis reporting on stresses seen in an osteoporotic fracture model treated with LLP or rIMN individually. 8,9 With cyclical loading of an LLP, stress forces were concentrated on the lateral side near the plate with minimal forces on the medial femur.…”