12 - Femur Trauma Plating Fixation

Abstract

Femur bone fracture fixation has been found to have a high rate of malunion and nonunion complications, which is due to instability of the fracture fixation under physiological loading conditions. Therefore, biomechanical factors that affect the stability of femur fracture fixation need to be extensively studied. Trauma plating implants have been developed for fixation of femur fracture, particularly at distal and proximal thirds. Biomechanical evaluation methods have been developed to examine implant strength under compressive, bending, and torsional loading. Furthermore, shear strength between the screws and bone fragments has been found very critical to prevent siding of bone fragments over the screws and causing malunion, loss of reduction, or even nonunion. The plating parameters such as plate type, screw type, plate length, screw configuration, lagging of bone fragments, postoperative loading regime or plan, length of bridging over the fracture site, interfragmentary compression, screw augmentation, locking mechanism, etc. are assessed preoperatively to adapt to bone mineral density, patient’s postoperative demands, and soft-tissue injuries. The clinical factors such as minimal invasive operation (or minimal incision creation for implantation), maximal range of motion, early mobilization, preservation of vascularization, elimination of soft tissue irritation, fracture union with good bone solidification, etc. are also considered to utilize the best fixation method for treatment of femur fractures. In this chapter, these biomechanical and clinical factors are reviewed for trauma plating systems and their advantages and disadvantages are discussed.