Effectiveness of the Dynamic Internal Fixator System in Metaphyseal and Epiphyseal Femoral Fractures: 10 Years of Experience and Future Expectations.

Abstract

Angular stability plates are largely used for treating complex fractures, but the incidence of nonunion is high. The innovative dynamic internal fixator (DIF) system is comprised of a plate with angular stability that combines the principles of internal fixator with dynamic device. In this study, we evaluate the feasibility of surgical reconstruction using the DIF in adult patients with epiphyseal-metaphyseal femur fractures and examine complications and outcomes at long-term follow-up. We retrospectively analyze 26 patients (14 females and 12 males), with a mean age of 64 yr, who were treated for femoral fractures between 2008 and 2017. Primary fractures were stratified according to the Muller AO Classification of fractures (mostly types 33-A3 and 31-A3). One patient was treated for a periprosthetic fracture and another for the early breakage of a conventional plate. Mean overall follow-up was 4.3 yr. Fracture healing with complete bony consolidation was achieved in 25 of 26 patients (96%). Two patients experienced complete union after revision surgery. The mean time to bridging callus formation was 58 d (range, 41 d to 4 mo) and to radiographic union was 4.6 mo (range, 1.2 to 12.5 mo). Dynamization of the system was performed in 16 cases. The following major complications occurred in 15% of cases: wound dehiscence (1), nonunion (2), and deep infection (1). No implant breakdowns were observed. The DIF system merged the advantages of angular stability plates with the possibility of dynamization, increasing fracture site compression to modulate and guarantee the healing process.