Abstract
BackgroundPlate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method.MethodsThis retrospective study included 71 distal femoral fractures of 70 patients who were treated with the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Univariate analysis was performed on them.ResultsOf 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non-union. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm.Non-union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p = 0.06). In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes.ConclusionsWe concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate.
Highlights
Distal femoral fractures comprise only 0.4% of all fractures and 4–6% of femoral fractures [1, 2]
We investigated (1) bone union rate, (2) bridge span length, (3) plate span ratio, (4) number of empty holes, and (5) medial fracture distance
Fourteen of all comminuted fracture cases and bone union were treated through shortening the fracture site as Rekha reported [16], and non-union was not observed in these cases
Summary
Distal femoral fractures comprise only 0.4% of all fractures and 4–6% of femoral fractures [1, 2]. The non-union rate of distal femoral fractures lies between 0 and 34%, indicating considerable variation [3, 4]. Surgical treatment can either be retrograde intramedullary nail fixation or be plate fixation, with plate fixation having a wide indication for various fractures types [5, 6]. It is impossible to achieve absolute stability with rigid internal fixation in comminuted fractures. In such cases, it is necessary to use a locking plate as a bridging plate to fix the fracture site [8]. Plate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method
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