Evaluation of the Results of Minimally Invasive Plate Osteosynthesis Using a Locking Plate in the Treatment of Distal Femur Fractures.

Abstract

IntroductionDistal femur fractures are serious injuries that can be difficult to treat, carry an unpredictable prognosis, and lead to long-term disability and morbidity. The introduction of minimally invasive plate osteosynthesis (MIPO) avoids direct exposure of the fracture site, improves fracture healing and decreases the incidence of complications. The aim of this study was to assess prospectively the early results of the treatment of supracondylar fractures of the femur using minimally invasive percutaneous osteosynthesis using a distal femoral locking plate. The study was a prospective study that included 20 adult patients who sustained distal femur fractures.Materials and methods The study was a prospective study that included 20 patients suffering from supracondylar fractures of the femur. All patients had fixation of the fracture using a distal femur locking plate (less invasive stabilization system (LISS)) in a minimally invasive technique using an anterolateral or direct lateral approach to the distal femur according to the fracture classification. The follow-up was done using the functional evaluation scale for distal femoral fractures as regards range of motion, deformation, pain, walking ability, and return to work.ResultsThe mean age was 52.80 (19-80) years. The mean body mass index of the patients was 28.50, with a range of 23-43 kg/m2. The mechanism of trauma was road traffic accidents (RTAs) in nine patients (45%) and falling from standing height in eleven patients (55%). Fractures were classified according to the Arbeitsgemeinschaft Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) classification. All patients were followed up for a period of six months and assessed in terms of knee range of motion, deformation, pain, walking ability, and return to work. The mean time of radiological union, in which bony trabeculae crossed the fracture gap, was 3.45 ± 0.79 months. The final results obtained were excellent in four patients (20%), good in nine patients (45%), fair in five patients (25%), and poor in two patients (10%). Complications encountered were knee stiffness (20%), superficial wound infection (10%), and shortening (15%).ConclusionLISS plating using the MIPO approach is useful in treating complex distal femoral fractures. Large studies from independent centers reporting long-term results are needed to further evaluate the role of LISS plating and the MIPO approach in the management of complex distal femoral fractures.