Distal Femoral Locking Compression Plate Research Articles

The functional outcome of surgical management of distal femur fractures using a distal femoral locking compression plate.

Objective: To evaluate the functional outcomes following surgical intervention for distal femur fractures using femoral locking compression plates. Study Design: Descriptive study an Observational study. Setting: Department of Orthopedics, MTI Mardan Medical Complex in Mardan. Period: January 2023 to December 2023. Methods: Was conducted on 86 patients with distal femur fractures treated with femoral locking compression plates at the Orthopedic Ward. The sampling method employed was non-probability consecutive sampling. All surgeries were performed using a standardized technique by an experienced surgeon. Functional outcomes were assessed using the Oxford Society score six weeks post-procedure. Data analysis was conducted using SPSS 23, with significance set at p ≤ 0.05. Results: Of total 86 patients, n=57(66.3%) were male while n=29(33.7%) were female. Mean age was 35.43±10.49. Overall, 39 patients (45.3%) had excellent functional outcomes, 22 patients (25.6%) had good functional outcomes, 13 patients (15.1%) had fair functional outcomes, and 12 patients (14.0%) had poor functional outcomes. After cross tabulation with functional outcomes, gender and BMI were found insignificant with p value of 0.584 and 0.399 respectively. While diabetes, hypertension and age was found to be significantly associated with functional outcomes with p value of <0.001,0.005 and <0.001 respectively. Conclusion: The use of locking compression plates for distal femur fractures resulted in predominantly favorable functional outcomes with minority of patients experiencing poor outcomes. Additionally, diabetes, hypertension, and age emerged as significant predictors of functional outcome.

Functional Outcome of Locking Compression Plate in Distal Femur Fractures

Introduction: Distal femur fracture is common in young people with high velocity injury. Management of distal femur fractures is a therapeutic challenge in orthopedics practice due to its extensive soft tissue injuries, bone loss, comminution, articular extension, instability.Open reduction with internal fixation replaces previous trend of closed conservative management and external fixation. Distal femoral locking compression plate (DF-LCP) requires both locking and compression screw fixation of the femur shaft. DF-LCP has been rapidly adopted as an alternative to intramedullary nails, blade plates and non-locking condylar screw.Materials and Methods: Prospective interventional study was done in department of orthopedics at National Medical College and Teaching Hospital, Birgunj for one year among 45 patients of age more than 18 years with post traumatic closed or open GA Type I, II distal femur fractures, AO Muller type A and C fractures. Ethical approval was obtained from institutional review committee and proper informed consent was taken. Type of implant used was DF-LCP.NEER’S scoring system was used for functional outcome.Results: Out of 45 patients, 42 patients with distal femur fracture were treated by DF-LCP.Three patients lostduring follow up hence removed from study. Out of 42 patients, mean age of the patients was 36.62 years. Most of them 31, (73.8%) were male. Predominant fracture was on right side 29 (69%).The study finding showed that 30 (71.4%) sustained injury due to road traffic accidents. Most of the patients 18 (42.9%) had type A2 fracture according to AO Muller distal femur fracture classification. Complications like surgical site infection observed in 3 cases. 100% union rate achieved with an average union time of 17.26 weeks. On evaluation according to Neer’s criteria mean score was 82.1 (Range: 48-96). Out of 42 patients 24 (57%) had excellent, 14 (33%) had good, 3 (7.2%) had fair and 1 (2.4%) had poor result.Conclusion: The study concluded DF-LCP is effective treatment for distal femur fracture. It provides stable construct for fracture union with excellent functional outcome.

Is augmented femoral lateral plating with helically shaped medial plates biomechanically advantageous over straight medial plates?

Dual plating of comminuted distal femoral fractures allows for early patient mobilization. An additional helically shaped medial plate avoids the medial vital structures of the thigh. The aim of this study is to investigate the biomechanical competence of an augmented lateral locking compression plate distal femur (LCP-DF) using an additional straight versus a helically shaped medial LCP of the same length. Ten pairs of human cadaveric femora were instrumented with a lateral anatomical 15-hole LCP-DF. Following, they were pairwise instrumented with either an additional medial straight 14-hole LCP (group 1) or a 90°-helical shape LCP (group 2). All specimens were biomechanically tested under quasi-static and progressively increasing combined cyclic axial and torsional loading until failure. Initial interfragmentary axial displacement and flexion under static compression were significantly smaller in group 1 (0.11 ± 0.12 mm and 0.21 ± 0.10°) versus group 2 (0.31 ± 0.14 mm and 0.68 ± 0.16°), p ≤ 0.007. Initial varus deformation under static compression remained not significantly different between group 1 (0.57 ± 0.23°) and group 2 (0.75 ± 0.34°), p = 0.085. Flexion movements during dynamic loading were significantly bigger in group 2 (2.51 ± 0.54°) versus group 1 (1.63 ± 1.28°), p = 0.015; however, no significant differences were observed in terms of varus, internal rotation, and axial and shear displacements between the groups, p ≥ 0.204. Cycles to failure and load at failure were higher in group 2 (25,172 ± 6376 and 3017 ± 638 N) compared to group 1 (22,277 ± 4576 and 2728 ± 458 N) with no significant differences between them, p = 0.195. From a biomechanical perspective, helical double plating may be considered a useful alternative to straight double plating, demonstrating ameliorated damping capacities during flexion deformation and safer application as the medial neurovascular structures of the thigh are avoided.

Biomechanical study of the stiffness of the femoral locking compression plate of an external fixator for lower tibial fractures

BackgroundA locking compression plate (LCP) of the distal femur is used as an external fixator for lower tibial fractures. However, in clinical practice, the technique lacks a standardized approach and a strong biomechanical basis for its stability.MethodsIn this paper, internal tibial LCP fixator (Group IT-44), external tibial LCP fixator (Group ET-44), external distal femoral LCP fixator (Group EF-44, group EF-33, group EF-22), and conventional external fixator (Group CEF-22) frames were used to fix unstable fracture models of the lower tibial segment, and anatomical studies were performed to standardize the operation as well as to assess the biomechanical stability and adjustability of the distal femoral LCP external fixator by biomechanical experiments.ResultsIt was found that the torsional and flexural stiffnesses of group EF-44 and group EF-33 were higher than those of group IT-44 and group ET-44 (p < 0.05); the flexural stiffness of group EF-22 was similar to that of group IT-44 (p > 0.05); and the compressive stiffness of all three EF groups was higher than that of group ET-44 (p < 0.05). In addition, the flexural and compressive stiffnesses of the three EF groups decreased with the decrease in the number of screws (p < 0.05), while the torsional stiffness of the three groups did not differ significantly between the two adjacent groups (p > 0.05). Group CEF-22 showed the highest stiffnesses, while group ET-44 had the lowest stiffnesses (P < 0.05).ConclusionsThe study shows that the distal femoral LCP has good biomechanical stability and adjustability and is superior to the tibial LCP as an external fixator for distal tibial fractures, as long as the technique is used in a standardized manner according to the anatomical studies in this article.

A Prospective Study on Surgical Management of Closed Distal End Femoral Fracture in Adults Using Distal Femur Locking Compression Plate

Background: Distal Femur fractures are a highly incident complex case and pose a challenge to the treatingorthopedician.Aims and Objectives: The aims and objectives of this study were to assess radiological union of distal femoralfractures by open reduction and internal fixation with locking compression plate, To study the functionaloutcome for internal fixation of fractures of the distal end femur by Locking Compression Plate and Toevaluate the effectiveness and complications of distal end femur fractures treated with Locking CompressionPlate based on, time till union, rate of infection, and fixation failures, functional outcome using NEER’S SCORE.Materials and Methods: The present study was done from April 2017 to April 2018 which comprised offifteen patients with closed Distal end Femoral Fractures who where treated by Locking Compression plate.Overall final outcome was assessed in terms of radiological union, clinical assessment and regaining the lostknee function using NEER’S Score.Results: Out of 15 patients, 12 patients were males and 3 patients were females.Out of 15 patients, 14 were due toRTA. Maximum number of cases was of Muller type C2-60%. Internal fixation was considered after patientsgeneral and medical condition was stabilized. The average operative time was 90 minutes. The size of plate wasselected based on the type of fracture. 6 to 10 hole plate were used most commonly. Of 15 patients, 10(66.66%)showed radiological union within 16 weeks. 9 (60%) of the patients achieved weight bearing at the end of 14weeks. Average flexion in this study was 100 degree with more than 3 (20%) patients having knee range ofmotion more than 110 degree. 1 Patient had stiff knee. More than 80% patients were extensor lag less than 5degree. 2 patients had VARUS MALALIGNMENT out of 15 patients.Results according to NEER’S SCORE wereExcellent in 20% patients, Good in 60% , Satisfactory in 6.6% and unsatisfactory in 13.3% patients. 2 patients hadsuperficial infection and 1 patient had delayed union.Conclusion: Locking compression plate is an optimal tool for Distal end femoral fractures. It provides rigidfixation in the region of femur, where a wide canal, thin cortices and frequently poor bone stock make fixationdifficult.

A COMPARATIVE STUDY IN MANAGEMENT OF DISTAL FEMUR FRACTURES BY DISTAL FEMUR LOCKED COMPRESSION PLATE VERSUS RETROGRADE NAILING

Background : Distal femoral fractures comprise approximately 3%–6% of all femoral fractures. The associated mechanism of injury can be of high or low energy. Surgery is the standard mode of treatment aiding for early weight bearing and mobilization is required in order to prevent longterm complications due to prolonged bed rest. Open reduction and internal xation using extra-medullary implants have been the standard treatment for supracondylar fractures, irrespective of age group with high complication rates including delayed union; implant failure, and infection. Transmedullary nail offers a potential biomechanical advantage over side plates and screws because of intramedullary location; resulting in less stress over the implant and better stress distribution than with eccentric side plate and screws.6 While both techniques are considered standard , the merits and demerits of each technique may be different; leading to better results or alignment using one over the other. This study aims at comparing the two xation methods. A total of 70 patients who met the inc Materials and methods: lusion criteria were included in the study and were divided into 2 groups- Group A comprised those patients treated with Retrograde Nailing (n=35) while Group B patients were treated with Distal Femur Locking Compression Plate(n=35). All post-operative patients were evaluated at 2weeks, 4weeks, 3 months and 6months. Results and conclusion: It was found out that the mean Range of Motion (ROM) evaluated at 6 months was 119.85 (-+21.11) degrees for the RN group while it was 110.0(-+18.85) degrees in the DFLCP group and was statistically signicant with p=0.044 , also the functional outcome assessed by AKSS was statistically signicant (p=0.03) favoring the RN group over the DFLCP group. Similar signicant outcomes were obtained in terms of duration of surgery and amount of blood loss favoring RN group . The radiological union time for RN group was 12 weeks compared to 13.21 weeks in case of DFLCP group , but was not statistically signicant (p=0.100). Hence , distal femur fractures especially the extra articular type had good outcome when treated with RN compared to DFLCP , when intervened early and coupled with adequate post operative physiotherapy.

A study of functional outcome of distal femur fractures internally fixed with distal femur locking compression plate

The femur is the largest bone in the body connecting between the tibia and pelvic bone. Studies have proved this bimodal distribution of supracondylar fractures of the femur. The locking plate's standard is to have an anatomical reduction of the bone under the soft tissue envelope and could be applied without stripping the periosteum.&#x0D; The aim: to study the union rates with locking compression plates and clinical outcome associated with this treatment modality, range of movements of the knee, pain relief and return to normal activities and work.&#x0D; Methodology: this is a prospective study on patients with distal femur fractures. Conducted at Santhiram medical college and general hospital, Nandyal from October 2018 to September 2020. All patients aged more than 18 years diagnosed with distal femur fractures.&#x0D; Results: in our study, around 46 % of them had Muller A1 type, followed by 23 % had Muller C1 and C2 respectively, and the remaining 13.3 % had Muller A2. Around 67 % had a Thomas splint with traction, 16.7 % had B.B. splint, 13.3 % had A/K POP slab, and the remaining 3 % had upper tibial traction with B.B. splint. The majority of the study participants, 53 %, had knee flexion more than 120 degrees. 30 %, took &lt;16 weeks for the union, 33 %, took 16-20 weeks to complete weight-bearing, eight patients (26 %) had excellent outcomes; 21 patients (70 %) had a satisfactory outcome; one patient (3.3 %) had an unsatisfactory outcome.&#x0D; Conclusion: in our study, out of 30 patients, eight patients had excellent outcomes, 21 patients had satisfactory outcomes, and one patient had unsatisfactory outcomes. We conclude, open reduction and internal fixation with a locking compression plate resulted in good clinical and radiologic outcomes

Failure of Distal Femoral Locking Plate: Case Report

The Less Invasive Stabilization System (LISS) and titanium distal femoral locking compression plate (DF-LCP) was designed by the AO Group to combine the advantages of both interlocked intra-medullary nailing and biological plating techniques in one system. The stiffness of the construct is similar to a 95° condylar plate, dynamic condylar screw, or condylar buttress plate.&#x0D; We report a case of the DF-LCP and screw breakage. Early weight bearing and lack of callus consolidation precipitated failure of the implant. Non-weight bearing and early autologous bone grafting may be indicated in open distal femoral fractures.

A comparative study of the outcomes of fixation of fractures of distal femur by femoralnailing vs distal femoral locking compression plate

: Distal femoral fractures are much less common than hip fractures and account for 7 % of all femoral fractures. To determine the fracture characteristics (AO type, Muller’s classification). To study the advantages of fixation with distal femoral locking compression plates and retrograde intramedullary supracondylar nailing. The present comparative study was conducted between May 2019 to November 2020 in department of othropeadics. Sample size of 30 patients presenting with supracondylar fractures of the femur were treated by distal femoral locking compression plates, dynamic condylar screws and retrograde supra condylar nailing.Out of 30 cases those treated by supracondylar nail had an average healing time of 14.8 weeks and those treated by locking compression plate had an average healing time of 15.9. Among the 30 cases of supracondylar fracture fixed by supracondylar nail 14 were scored as good and one was scored as excellent, whereas those fixed by locking compression plate 14 were scored as good and 1 cases was scored as fair. Out of 30 cases of supracondylar fracture fixed none had any intraoperative complications barring one which had break of drill bit intraoperatively and stayed insitu to the bone, there were no intances of surgical wound infections. The intraoperative blood loss was significantly lower when the fractures were fixed by supracondylar nail which averaged to 150ml when compared to the fixations by locking compression plate which averages to 300ml.The supracondylar nail is more ideal when compared to the distal femoral locking compression plate as there is less operation time, less blood loss, more range of movement, less soft tissue stripping &amp; faster radiological union when compared to the distal femoral locking compression plate. Fracture personality &amp; soft tissue quality.

A comparative study of functional outcome of extra articular distal femur fractures treated, with retrograde nailing versus locking compression plate

Aim: To compare the functional outcome of supracondylar fractures of distal femur managed by Supracondylar nailing (retrograde) and locking femoral compression plate. Introduction: Before 1980, supracondylar fractures of the femur were treated with nonlocking plates. Plaster immobilization and traction were modes of treatment for non-operative patients. Nowadays, the knowledge of internal fixation has evolved as to treat complex fractures by cancellous screws, 95-degree blade plates, dynamic condylar screw and plate, condylar buttress plates, locking femoral compression plates and supracondylar nailing (retrograde). Trending procedures for supracondylar fractures of the femur are supracondylar nail (retrograde) and locking femoral compression plate. Materials and Methods: Totally 30 patients of extra-articular distal femur fractures treated in Rajah Mathai Medical College from May 2019 to June 2021. Patients were treated by random allocation as 15 patients by retrograde nailing and the other 15 patients by distal femur locking compression plate. Functional outcome was compared between them according to Neer’s Scoring System at 24 weeks. Results: In our study, the patients were screened up to 1 year. The assessment was based on both radiologically and clinical scoring. Neer's score was higher in nailing (54%) compared to plating (46%). Conclusion: From our study, nailing proved to have a good functional outcome in terms of early weight-bearing, knee flexion and less union time. Both nailing and plating have excellent results with proper preoperative planning.

Reverse Contralateral Distal Femoral Locking Compression Plate for Subtrochanteric Femoral Fractures: A Comparative Retrospective Study with Cephalomedullary Nail and Technical Note

Background: Cephalomedullary nails (CMN) have been proven to be the implant of choice in Subtrochanteric Femoral Fractures. The reverse contralateral distal femoral locking compression plate (DF-LCP) is an alternative fixation in cases that are unsuitable for nailing. The comparative studies made of these two fixation techniques are inadequate. Objective: To retrospectively analyze and compare the outcomes of these two fixation techniques and demonstrate the apparent surgical technique for applying the reverse contralateral DF-LCP. Materials and Methods: The present study included patients over 18 years of age diagnosed of subtrochanteric fractures and treated with either DF-LCP or CMN. Retrospective comparative analyses of union time, operative times, estimated blood loss, and complications were conducted from their medical records and serial radiographs. The surgical technique for reverse contralateral DF-LCP fixation is also described in the present study. Results: The present study enrolled 106 eligible patients, in which 33 patients were treated with reverse contralateral DF-LCP, and 73 patients with CMN. There were no significant differences in age, gender, type of fracture, or history of smoking between the two groups. However, there were significant differences in the requirements of the open reduction technique with 26 fractures (78.8%) in the DF-LCP group and 17 fractures (23.3%) in the CMN group (p&lt;0.001). The comparative outcomes of the DF-LCP and CMN groups demonstrated the statistically significant difference in the number of malreductions or malunions, comprising four events (12.1%) and 22 events (30.1%), respectively (p=0.036). There were no statistically significant differences in terms of union time, operative time, and the amounts of estimated blood loss. Conclusion: The reverse contralateral DF-LCP fixation technique demonstrated comparable outcomes in terms of union time, operative time, and blood loss, and was deemed a safe procedure for subtrochanteric femoral fracture. Lower occurrences of malreduction or malunion complication were shown in DF-LCP group. Keywords: Subtrochanteric fracture; Reverse contralateral distal femoral locking compression plate; Cephalomedullary nail

The Treatment of Subtrochanteric Fracture with Reversed Contralateral Distal Femoral Locking Compression Plate (DF-LCP) Using a Progressive and Intermittent Drilling Procedure in Three Osteopetrosis Patients.

ObjectiveTo describe the application of reversed contralateral distal femoral locking compression plate (DF‐LCP) inserted through a progressive and intermittent drilling procedure in the treatment of osteopetrotic subtrochanteric fracture (OSF).MethodsThree patients (one male and two females with an average age of 45.33 ± 11.09 years) with OSF hospitalized between September 2015 and September 2020, were included in this present study. Lateral approach was applied in all patients who accepted open reduction and internal fixation (ORIF) with a reversed contralateral DF‐LCP inserted through a progressive and intermittent drilling procedure. The operation time and intraoperative blood loss were recorded to evaluate the efficiency of this surgical method. Physical examination and imaging examination of the fracture site were used to evaluate the fracture union status, the position and stability of the implant, and the alignment of the injured limb at 1, 3, 6, and 12 months after operation, then a subsequent visit was conducted at least once a year. Harris Hip Score (HHS) was used to evaluate the hip joint function at 6 and 12 months after operation.ResultsThe average operation time was 140 ± 21.60 min (110, 160, and 150 min); The average intraoperative blood loss was about 333.33 ± 23.57 ml (300, 350, and 350 ml). The average follow‐up time was 22.33 ± 7.41 months (29, 26, and 12 months). All patients achieved bone union with an average time of 6.67 ± 0.94 months (6, 8, and 6 months). At the time of 6 months after operation, case 1 and 3 were almost pain‐free and could walk with full weight bearing while case 2 could walk only with partial weight bearing using a crutch. The HHS scores of cases 1, 2, and 3 were 84/100, 74/100, and 92/100, respectively. At the follow‐up at 12 months after operation, the HHS score improved to 91/100, 81/100, and 96/100, respectively. The contralateral incomplete old subtrochanteric fracture was deteriorated in case 1 at 26 months after operation. After 3 months of limited weight bearing using a crutch, bone union was verified in radiograph imaging. Fresh contralateral subtrochanteric fracture occurred in case 2 at 26 months after operation, which was treated using a similar surgical approach, and its clinical outcome is under follow‐up. Moreover, no perioperative complications including operation‐related death, vascular/nerve injury, deep venous thrombosis, pulmonary embolism, and incision infection, and long‐term complications involving malunion, nonunion, implant failure, ankylosis, heterotopic ossification, osteonecrosis, and osteomyelitis were identified.ConclusionThe application of reversed contralateral DF‐LCP in OSF is practicable and reliable. Progressive and intermittent drilling is a safe and efficient method for implant insertion in this complicated situation.

RETROGRADE INTRAMEDULLARY SUPRACONDYLAR NAILING AND DISTAL FEMORAL LOCKING COMPRESSION PLATE IN THE MANAGEMENT OF DISTAL FEMUR FRACTURES – A COMPARATIVE STUDY

Objectives: The objective of the study is to assess the efficacy of retrograde intramedullary interlocking supracondylar nailing and distal femoral locking compression plate in the management of distal femur fractures. Methods: The present prospective study consists of a total of 36 cases with extra-articular supracondylar fractures of the femur between the age group of 21–70 years. Participants were randomly allocated to group 1 treated with distal femoral locking compression plate fixation and group 2 treated with retrograde intramedullary interlocking supracondylar nailing technique. Post-operatively, all the cases were followed up in regular intervals to assess the functional outcome using the American Knee Society score. Results: Road traffic accidents (80.56%) were the most common cause of injury. The average surgical duration (108 min and 90.14 min), duration of fracture union (12.48 weeks and 11.08 weeks), and blood loss (339.8 ml and 236.6 ml) was better in the nailing group than the plating group, respectively. The overall outcome was comparable between the two study groups. Conclusion: The supracondylar nailing technique has better functional outcomes in terms of less fracture union time, less operative duration, and minimal operative blood loss. Supracondylar nailing technique was effective and better in soft tissue damage control.

DISTAL FEMUR FRACTURES FIXATION BY LOCKING COMPRESSION PLATE-ASSESSMENT OF OUTCOME BY RASMUSSENS FUNCTIONAL KNEE SCORE

Background: The choice of distal femur locking plate in distal femur fractures has been a topic of debate. This study was performed to evaluate theresults of distal femur locking plate in distal femur fractures. Material and Methods: A prospective randomized study of 30 patients with distalfemur fracture was conducted at Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana(Ambala), Haryana from January 2020 to July 2021 and followed up from 6months to 18 months for a minimum of 6 months duration. Implants used: The distal femur locking compression plate. Classification system: AO Classification. Results &amp; Observations: Clinical and functional outcomes were assessed using Rasmussens functional knee score.Complications of fractures and operative treatment were assessed. The results of entire study group showed 18 excellent, 10 good, 1 fair and 1 poor. Conclusion: We observed and recommend that the distal femur LCP is an optimal tool of good fixation for fractures of distal femur.

Assessing the functional outcome after fixation of distal femoral fractures with DF-LCP: A prospective study.

Background: Management of distal femoral fractures remains a real challenge due to the involvement of unique and vital anatomical structures. These are usually treated with operative measures. Distal femoral locking compression plate (DF-LCP) has gained popularity due to favorable biological insertion and minimal periosteal damage, but locally little is known about it. Therefore, the present study aimed to identify the functional outcomes after fixation of distal femoral fractures with DF-LCP.&#x0D; Methodology: This prospective cohort study, including 21 patients with distal femoral fractures, was conducted at Abbasi Shaheed Hospital from Jan 1, 2017, to Dec 31, 2018. All enrolled patients were treated with DF-LCP. The postoperative clinical and radiological outcomes were evaluated for one year. The data were statistically analyzed using SPSS version 22.0.&#x0D; Results: There were 21 patients with distal femur fractures with a mean age of 46.6 ± 19.2 years. The majority of the fractures were due to road traffic accidents (RTA), i.e., 57.1%, followed by ground-level fall (33.3%). The mean time for fracture union was 20.2 ± 11.1 weeks, and the mean range of motion of the knee was 108.5 ± 18.5º (at one-year follow-up). The complications were minimal; superficial infection and stiffness of knee joint were observed in 2 patients each while there was 1 case each of non-union, delayed union, and implant failure.&#x0D; Conclusion: DF-LCP is an effective treatment for distal femoral fractures as it permits stable fixation and early mobilization. Satisfactory to excellent functional and radiological outcomes were achieved.&#x0D;

The utility of reverse distal femur locking compression plate in minimally invasive osteosynthesis for type C subtrochanteric fractures of the femur: technical description and a clinical series of 50 cases.

Establishing fracture consolidation and avoiding postoperative complications of comminuted subtrochanteric fractures of the femur are technically challenging. The authors delineated a technical description of minimally invasive plate osteosynthesis (MIPO) by using a reverse distal femur locking compression plate (LCP-DF) and retrospectively reviewed the outcomes of these particular fractures. Fifty patients with 51 type C subtrochanteric fractures of the femur were operated on by MIPO and reverse LCP-DF fixation. The collected data included postoperative complications, union times, and clinical outcomes. All fractures were united with a mean union time of 19.4weeks (range 16-22). Regarding postoperative complications, asymptomatic valgus angulation occurred in five patients and trochanteric pain in six. According to Harris hip score, nine patients were determined to be excellent, 36 to be good and five to be fair. MIPO by reverse LCP-DF is reliable and effective for type C subtrochanteric fractures of the femur particularly in situations where intramedullary nailing is not feasible.

Long Low-profile Proximal Tibial Locking Plate for the Fixation of Periprosthetic Femoral Fractures Above the Prosthesis: A Pilot Study

Background: Anatomic distal femoral plates locking compression plate (LCP) are generally used for the fixation of distal femoral fractures. However, they are not suitable for periprosthetic femoral fracture after total knee arthroplasty (TKA), mainly owing to the impingement with prosthesis. Objectives: In this case series, we report the outcome of proximal tibial LCP fixation in the treatment of periprosthetic femoral fracture after TKA. Patients and Methods: Twelve patients with a periprosthetic femoral fracture who underwent surgical treatment were included. According to Su et al. classification, all fractures were type II, originating from the femoral component with proximal extending. Fractures were managed with open reduction and plate fixation. The plate choice was either a long low-profile proximal tibial LCP (n=9) or a short anatomic distal femoral LCP (n=3). Results: The study population included one male and 11 females with a mean age of 74.5±9.3 years and a mean follow-up of 2.8±1.3 years. Union of fracture was observed in all fractures that were fixed with a long locking plate during a mean period of 3.1±2.1 months. Fixation failed in all three patients who were managed with a short plate. These patients underwent revision surgery with a long low-profile proximal tibial LCP. In one of them, the fixation failed again and finally fixed with tumor prosthesis. The other two fractures were united with no complications. Conclusion: Long low-profile proximal tibial LCP omits the problem of impingement by prosthesis, which is caused by short anatomic distal femoral LCP in the treatment of periprosthetic femoral fractures above the prosthesis. However, future large-scale comparative studies are required before we can recommend it for routine implications in these fractures.

Reverse distal femoral locking compression plate (DF-LCP), does it fit and how to fit on Asian's proximal femurs? A cadaveric study.

Reverse distal femoral locking compression plates (DF-LCP) have been used as an alternative treatment in complex proximal femur fractures. The purpose of this study was to assess the compatibility of reverse DF-LCP with Asian proximal femurs, to determine the matching patterns and integrate information to establish guidelines for correct application. Twenty-eight adult cadaveric femurs were obtained from 5 males and 9 females with an average age of 69.27years (range 59-85). A contralateral 13-hole DF-LCP was applied with MIPO technique using the vastus ridge as a landmark for Hole A. The first locking screw was inserted through Hole A under fluoroscopic guidance just above the femoral head-neck junction in AP view and centered of the neck in lateral view, followed by three proximal locking screws. The number of screws successfully inserted through the femoral neck, including any penetration of femoral neck, the gap between anterior and posterior borders between plate and bone, the anatomical parameters of proximal femur, and any mismatches between the plate and the bone were recorded. Most of the screws (82.1%) in Holes A, D, E, and F were put into the femoral neck without breaking through. The average distance from the entry point at the vastus ridge to the anterior cortex of the femur was 17.3 ± 2.3mm and from the posterior cortex was 19.46 ± 2.55mm. The anterior gap was 4.93 ± 1.01mm, and the posterior gap was 13.48 ± 1.44mm. The mismatch where the distal part of the plate started to lift off from the bone > 2mm at the 8th hole with an average distance of 2.78 ± 2.01 mm. That distance gradually increased distally to an average of 9.38 ± 6.03mm at the 13th hole. Reverse DF-LCP can fit most proximal femurs in the Asian population and can be used as an alternative implant when performed using an appropriate technique. However, as a relatively consistent mismatch was found at the distal part starting at the 8th hole, so if a plate is longer than 9 holes, the plate contouring should be considered.

Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty

IntroductionAdequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP).Materials and methodsBetween January 2010 and July 2019, 18 patients [mean age, 74.8 (68–89) years; average follow-up period, 14.8 (12–43) months] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was 1 year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening.ResultsThe average time to union was 18.4 weeks (range, 10–51 weeks) and to callus formation was 7.8 weeks (range, 2–14 weeks). At the 1-year follow-up, the average JLETS was 37.6 (range, 24–53), average knee ROM was 110.3° (range, 80–135°), and average varus-valgus angles of the distal femur were 3.2° (range, −2.9–10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients.ConclusionMIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

Comparative study of distal femoral locking compression plate and tens nail versus lateral distal femur plate in management of distal femur fracture cases

Background: The fracture of distal femur are often unstable and comminuted and as difficult to treat. The incidence of complications in these fracture are relatively high .The purpose of our study was aimed to compare functional outcome between both column fixations by using distal femoral locking compression pate on lateral side and then using TENS nail on medial side to obtain support of medial column versus lateral distal femoral plate.Methods: We have included 80 patients with distal femur fracture with intercondylar extension in our study. We have treated 40 patients with distal femoral locking compression plate and support of medial wall with TENS nail and 40 patients with distal femoral locking compression plate. There were sixty six males and fourteen females. The average age of the patients was 39.08 ± 11.95 years. All the patients were operated between 3 to 9 days. All patients were followed up at 2th, 6th, 10th weeks, 3 month and 6 month regularly and evaluated for fracture healing, Clinical union was defined as a painless fracture site during full weight bearing. Radiological union was defined as bridging trabeculation across the fracture site on three of four cortices. The final outcome was assessed according to schatzker and Lambert scoring system.Results: The result was excellent in twelve, good in fifteen, fair in ten and poor in one in DFLCP with TENS nail group according to schatzker and Lambert scoring system. The result was excellent in eight, good in twelve, fair in twelve and poor in five in DFLCP group according to schatzker and Lambert scoring system. The average time to Union was 17.7 weeks in DFLCP with TENS nail group and 19.9 weeks in DFLCP group. Complications include superficial wound infection in three patients, secondary osteoarthritis in 17 patients and varus angulation in three patients in DFLCP with TENS nail group. In DFLCP group varus angulation was in eleven patients.Conclusions: The use of TENS nail for medial femoral defect along with distal femoral locking compression plate may eliminate the need of plate on medial side. The varus angulation that occurs with defect is decreased and additional long incision and operative time is avoided.