Lateral locked plating for distal femur fractures by low-energy trauma: what makes a difference in healing?
- 356 Downloads
The objective of this study is to investigate healing outcome of lateral locked plating for distal femoral fractures caused by low-energy trauma. In addition, we sought to determine predictable factors associated with fracture healing time.
Seventy-three patients (73 fractures) with distal femur fractures (AO/OTA type 33) caused by low-energy trauma were recruited. The mean age of patients was 69.8 years (range, 43–87 years). All fractures were stabilized by less invasive osteosynthesis with anatomical periarticular locking system. Patients were followed up for mean 17.3 months (range, 6–44 months).
Of the 73 fractures, 52 (71.2%) fractures showed bony union within 6 months after the index surgery while the remaining 21 (28.8%) fractures showed delayed union or received revision surgery prior to complete healing. Although overall healing rate from the initial surgery was 93.2% (68/73), which seems to be satisfactory, the rate of surgical complications was 11.0% (8/73). Of all 73 fractures, seven received further surgery including three re-osteosynthesis. On multivariable analysis, plate-screw density at the fracture site was an independent predictable factor associated with the problematic healing.
Our findings suggest that complications related to increased healing time and fixation construct are not infrequent and ongoing problems in managing low-energy distal femur fractures. Specifically, plate-screw density at the fracture site has a significant influence on healing time in these fractures.
KeywordsDistal femur fracture Low-energy trauma Lateral locked plating
Compliance with ethical standards
This study was approved by the institutional review board.
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT, Appleton PT, Zurakowski D, Vrahas MS (2014) Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury 45:554–559CrossRefPubMedGoogle Scholar
- 4.Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL (2011) Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 25(Suppl 1):S8–S14Google Scholar
- 14.Niemeyer P, Sudkamp NP (2006) Principles and clinical application of the locking compression plate (LCP). Acta Chir Orthop Traumatol Cechoslov 73:221–228Google Scholar
- 15.Rozbruch SR, Muller U, Gautier E, Ganz R (1998) The evolution of femoral shaft plating technique. Clin Orthop Relat Res:195–208Google Scholar
- 18.Marsh D (1998) Concepts of fracture union, delayed union, and nonunion. Clin Orthop Relat Res:S22–30Google Scholar
- 20.Markmiller M, Konrad G, Sudkamp N (2004) Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? Clin Orthop Relat Res:252–257Google Scholar
- 21.Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL (2011) 2010 mid-America orthopaedic association physician in training award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res 469:1757–1765CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Silver JJ, Einhorn TA (1995) Osteoporosis and aging. Current update. Clin Orthop Relat Res:10–20Google Scholar
- 39.Özcan Ç, Sökücü S, Beng K, Çetinkaya E, Demir B, Kabukçuoğlu YS (2016) Prospective comparative study of two methods for fixation after distal femur corrective osteotomy for valgus deformity; retrograde intramedullary nailing versus less invasive stabilization system plating. Int Orthop 40:2121–2126CrossRefPubMedGoogle Scholar