Failure of LCP Condylar Plate Fixation in the Distal Part of the Femur: A Report of Six Cases

Abstract

The treatment of comminuted, intra-articular distal femoral fractures (Orthopaedic Trauma Association [OTA] classification1 33-C3) is challenging. Many of these injuries are the result of high-energy trauma, which generates severe soft-tissue damage and articular and metaphyseal comminution. Bone loss resulting from open fracture and poor bone quality may decrease the stability of fixation. Traditional devices for internal fixation have included the 95° condylar blade-plate, the dynamic condylar screw with a 95° side-plate, and intramedullary nails. However, coronal fractures or extensive distal comminution may preclude the use of these devices. In such cases, a lateral buttress or neutralization plate may be used. The condylar buttress plate was the first implant designed to serve this function. Unfortunately, when this device is applied in the presence of medial comminution or bone loss, failure of fixation and varus collapse may eventually result2,3. Recent advances in technology for the treatment of distal femoral fractures include the Less Invasive Stabilization System (LISS; Synthes, Paoli, Pennsylvania) and the Locking Compression Plate (LCP) condylar plate (Synthes)4-15. Each of these implants offers multiple points of fixed-angle contact between the plate and screws in the distal part of the femur, theoretically reducing the tendency for varus collapse that is seen with traditional lateral plates. The LISS differs from the LCP condylar plate in composition, shape, and placement. Early clinical studies of the LISS have demonstrated a high frequency of fracture union with low rates of malalignment7-9,15. Few cases of failure of the LISS have been reported11,12,16. To our knowledge, there have been no published studies focusing specifically on the LCP condylar plate and no reported cases of failure of this implant in the distal part of the femur. The purposes …