Outcomes of Distal Femur Non-Union Following Lateral Locked Plating Treated withan Addition of A Medial Locking Plate and Autogenous Bone Graft

Babaji Thorat

doi:10.32474/osmoaj.2020.04.000187

Abstract

Fractures of the distal third of the femur account for 4% to 6% of femur fractures and are a treatment challenge...

Highlights

Fractures of the distal third of the femur account for 4% to 6% of femur fractures and are a treatment challenge for orthopaedic surgeons despite new fixation options[1]
The surgical procedure was performed by same qualified orthopaedic surgeon involved careful dissection and elevation of medial soft tissues with either medial parapatellar or subvastus approach, packing the non-union site with autogenous bone graft obtained from the posterior iliac crest and fixation using medial locking plate and screws.Information obtained for each patient included patient demographics, injury details (Table 1), type of fracture, soft tissues at the time of original injury, details of prior surgeries, type of non-union, lateral and medial implant details, duration between the lateral locking plating and the secondary procedure, range of movements at the knee, pain score and ambulatory status before and after the surgery,postoperative complications (Table 2, 3)
None of the patients received any bone graft during primary surgery. 1/14 (7.1%) patients had a history of diabetes, while there was no history of smoking in any patient.One patient (Figure 1), case 10, a simple fracture treated for a peri-prosthetic fracture following total knee replacement done at our hospital, did not show any signs of healing after 8 months

Summary

Introduction

Fractures of the distal third of the femur account for 4% to 6% of femur fractures and are a treatment challenge for orthopaedic surgeons despite new fixation options[1]. Locked screws augment the stability of the construct by eliminating motion at the plate-bone interface providing greater pull-out strength[2,3]. The development of screw torque and plate-bone interface friction is unnecessary with locked plate designs, significantly decreasing the amount of soft tissue dissection required for implantation, preserving the periosteal blood supply[4]. Excellent stability provided by locking plates and minimally invasive biologically friendly insertion should lead to improved healing rates. Addition of medial locking plate and autogenous bone grafting adds biomechanical stability, prevents varus collapse and implant failure, and decreases the morbidity associated with non-union. We evaluated results of addition of medial locking plate and bone grafting in aseptic distal femur non-union with stable lateral implant

Methods

Results

Conclusion