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Tsegaye YA, Tegegne BB, Ayehu GW, Amisalu BT, Sulala AC. Prospective study on functional outcome of distal femur fracture treated by open reduction and internal fixation using distal femur locking plate in Tibebe Ghion Specialized Hospital, Bahirdar, North West Ethiopia. J Orthop Surg Res 2024; 19:582. [PMID: 39304870 DOI: 10.1186/s13018-024-05054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Distal femur fractures account for 6% of femur fractures. The treatment of distal femur fractures is challenging. Historically, nonoperative management has been the mainstay of management, which has evolved to operative management. There is no single implant used for all types of distal femur fractures. The implant evolves with time. The introduction of a distal femur locking plate (DF LCP) has had a great impact on the treatment. In developing countries like Ethiopia, there is scarcity of studies on functional outcome of operative treatment. So, this study aimed to assess the functional outcome of distal femur fractures treatment using distal femur locking plate. METHODS This prospective cohort study was carried out among adult patients with distal femur fractures treated using distal femur locking plate at Tibebe Ghion Specialized Hospital from august 2022 to July 2023. A total of 60 patients with AO Type A and Type C fracture were included. All patients were followed for 6 months. Functional outcomes were assessed using Neer's scoring system. Data was entered and analyzed using SPSS 27. Frequency, mean and cross tabulation were used to summarize descriptive statistics. Multinomial logistic regression was used to test the associations. RESULTS In our study out of 60 patients ,48.3% (29) had excellent functional outcomes, 30% (18) had good functional outcomes, 10% (6) had fair functional outcomes and 11.7% (7) had unsatisfactory functional outcomes according to Neer's scoring system. Patients with closed distal femur fractures had 5 times higher probability of excellent functional outcome than those patients with open distal femur fractures (AOR (2.49(5.8 ,1.07)). Patients who had regular follow up had 7 times higher probability of excellent functional outcome than those who had no regular follow up (AOR 7.16(1.11,46.22)). The average union period was 4.63 months, with only 2 patients experiencing delayed union. CONCLUSION Closed fracture and regular follow up were determining factors for better functional outcomes. Closed fractures preserve the biological environment, which facilitates early fracture healing. The regular follow up helped patients to assess their rehabilitation status and pick any complication early.
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Affiliation(s)
- Yonatan Abie Tsegaye
- Department of Orthopedics and Trauma Surgery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia
| | - Birhanu Beza Tegegne
- Department of Orthopedics and Trauma Surgery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia.
| | - Gashew Wale Ayehu
- Department of Anatomy School of Medicine, College of Medicine and Health Science, Deberetabor University, Deberetabor, Ethiopia
| | - Beedemariam Tadesse Amisalu
- Department of Orthopedics and Trauma Surgery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia
| | - Ashraf Chumeto Sulala
- Department of Orthopedics and Trauma Surgery, College of Medicine and Health Science, Bahirdar University, Bahirdar, Ethiopia
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Rosell-Pradas J, Redondo-Trasobares B, Sarasa-Roca M, Albareda-Albareda J, Puértolas-Broto S, Herrera-Rodríguez A, Gracia-Villa L. Influence of plate size and screw distribution on the biomechanical behaviour of osteosynthesis by means of lateral plates in femoral fractures. Injury 2023; 54:395-404. [PMID: 36528423 DOI: 10.1016/j.injury.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Distal femoral fractures are fractures associated with high rates of morbidity and mortality, affecting to three different groups of individuals: younger people suffering high-energy trauma, elderly people with fragile bones and people with periprosthetic fractures around previous total knee arthroplasty. They have been classically treated with conventional plates and intramedullary nails and more recently with locked plates that have increased their indications to more types of fractures. The main objective of the present work is the biomechanical study, by means of finite element simulation, of the stability achieved in the osteosynthesis of femoral fractures in zones 4 and 5 of Wiss, by using locked plates with different plate lengths and different screw configurations, and analysing the effect of screw proximity to the fracture site. A three dimensional (3D) finite element model of the femur from 55-year-old male donor was developed, and then a stability analysis was performed for the fixation provided by Osteosynthesis System LOQTEC® Lateral Distal Femur Plate in two different fracture zones corresponding to the zones 4 and 5 according to the Wiss fracture classification. The study was focused on the immediately post-operative stage, without any biological healing process. The obtained results show that more stable osteosyntheses were obtained by using shorter plates. In the cases of longer plates, it results more convenient disposing screws in a way that the upper ones are closer to fracture site. The obtained results can support surgeons to understand the biomechanics of fracture stability, and then to guide them towards the more appropriate osteosynthesis depending on the fracture type and location.
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Affiliation(s)
- J Rosell-Pradas
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - B Redondo-Trasobares
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - M Sarasa-Roca
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain
| | - J Albareda-Albareda
- Department of Orthopaedic Surgery and Traumatology, Lozano Blesa University Hospital, Zaragoza, Spain; Aragón Health Research Institute, Zaragoza, Spain; Department of Surgery, University of Zaragoza, Zaragoza, Spain.
| | - S Puértolas-Broto
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
| | | | - L Gracia-Villa
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain; Aragón Institute for Engineering Research, Zaragoza, Spain
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Gawhale SK, Kantharaju H, Kumar GSP, Shah N. "Shimming a Plate" Technique to Correct the Coronal Malalignment in Metadiaphyseal Distal Femur Fracture: Case Report. Indian J Orthop 2021; 56:501-504. [PMID: 35251514 PMCID: PMC8854520 DOI: 10.1007/s43465-021-00507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 09/02/2021] [Indexed: 02/04/2023]
Abstract
We present a case of 19-year-old male patient with right sided comminuted metadiaphyseal distal femur fracture. Fixation was done using distal femur condylar locking plate. Washers were used with the screws to shimming the plate to achieve the coronal alignment and prevent stress over the screws. 2-year follow-up shows good alignment, radiological union and functional outcome without any complications. "Shimming" a locking plate with washers helps to achieve the better coronal alignment in comminuted metadiaphyseal distal femur fractures with coronal malalignment. It reduces the stress over screws and prevents implant-related complications.
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Affiliation(s)
- Sangeet K. Gawhale
- Department of Orthopaedics, Grant Government Medical College, Mumbai, India
| | - H. Kantharaju
- Department of Orthopaedics, Government Medical College and Hospital, Nagpur, 440003 India
| | | | - Nadir Shah
- Department of Orthopaedics, Grant Government Medical College, Mumbai, India
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Jankowski JM, Szukics PF, Shah JK, Keller DM, Pires RE, Liporace FA, Yoon RS. Comparing Intramedullary Nailing Versus Locked Plating in the Treatment of Native Distal Femur Fractures: Is One Superior to the Other?. Indian J Orthop 2021; 55:646-654. [PMID: 33995868 PMCID: PMC8081772 DOI: 10.1007/s43465-020-00331-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 12/12/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Distal femur fractures make up < 1% of all fractures and 3-6% of all femur fractures. In the literature, both intramedullary nailing (IMN) and locked plating (LP) have shown favorable results, but there is no consensus on a gold standard. The purpose of this systematic review is to compare outcomes of native distal femur fractures treated via IMN versus LP in an effort to determine if one is superior to the other. METHODS Systematic review of MEDLINE, EMBASE, and Cochrane Library databases was conducted according to PRISMA guidelines. Only articles published within the last ten years were included. Evidence and study quality were evaluated with the MQOE and Oxford Criteria. RESULTS Forty-six articles were included in the review. Fractures treated with IMN were found to have a 93.9% union rate, an average time to union of 19.2 weeks, an average arc of motion of 105.1 degrees, with an average of 14.4 degrees of malalignment. Fractures treated with LP were found to have a 90.2% union rate, an average time to union of 20.5 weeks, an average arc of motion of 104 degrees, with an average of 12.6 degrees of malalignment. CONCLUSION Compiled data comparisons revealed no differences in union rate, malalignment, time to union, average arc of motion, or complication rates requiring a return to the operating room. Until higher level randomized data is available, either IMN or LP are acceptable methods of treatment for native distal femur fractures.
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Affiliation(s)
- Jaclyn M. Jankowski
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Patrick F. Szukics
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Jay K. Shah
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - David M. Keller
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Robinson E. Pires
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Felicio Rocho Hospital, Federal University of Minas Gerais, Belo Horizonte, MG Brazil
| | - Frank A. Liporace
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
| | - Richard S. Yoon
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Jersey City Medical Center-RWJBarnabas Health, 377 Jersey Ave, Suite 280A, Jersey City, NJ 07302 USA
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Campana V, Ciolli G, Cazzato G, Giovannetti De Sanctis E, Vitiello C, Leone A, Liuzza F, Maccauro G. Treatment of distal femur fractures with VA-LCP condylar plate: A single trauma centre experience. Injury 2020; 51 Suppl 3:S39-S44. [PMID: 31703959 DOI: 10.1016/j.injury.2019.10.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/18/2019] [Accepted: 10/22/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Given the recent criticisms in the literature regarding Synthes Variable Angle Locking Compression Condylar Plate (VA-LCP), the purpose of this study was to evaluate functional outcome, fracture healing, and complications of distal femoral intra-articular fractures using this device. METHODS Patients with distal femoral fractures treated with 4.5 mm VA-LCP Curved Condylar Plate were included in this retrospective study. Follow-ups were at 4 weeks, 3 months, 6 months and 1 year. For the clinical and functional assessment of the knee, WOMAC, Koos Knee Survey, the Knee Score Society and the SF-12 questionnaire were used. Radiographically we assessed the fracture healing and the angles of the operated limb compared to the healthy contralateral limb. Complications have also been described. RESULTS Forty-two patients with distal femoral fractures were included in the study. The mean follow-up was 8 months. Most cases (57%) reported a type 33-A fracture. Radiological healing was achieved in 33 cases; the mean time required to heal was 13 weeks. Three patients had an early postoperative complication and four cases had a late complication. Five cases required additional surgical procedures. Most patients (47.2%) achieved a complete flexion of 130° or more. WOMAC mean value 27.4%, KSS mean value 77.6 for the clinical part and 60 for the functional part, KOOS mean score 60.1, SF-12 mean score 46.1 for MCS and 35.5 for PCS. DISCUSSION The results of this retrospective study suggest that VA-LCP Curved Condylar Plates have a good functional outcome and fracture healing similar to other standard distal femoral locking plates. VA technology allows greater versatility in fractures internal fixation regardless of the plate design. Fixation devices or Prosthesis implants previously placed may be avoided, as in periprosthetic fractures. Moreover, we have not recorded any early mechanical damage. CONCLUSIONS Osteosynthesis with Synthes 4.5 mm VA-LCP Curved Condylar Plate demonstrated to have no early mechanical failure rate with good clinical and radiological results.
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Affiliation(s)
- V Campana
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italia
| | - G Ciolli
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italia
| | - G Cazzato
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italia.
| | - E Giovannetti De Sanctis
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italia
| | - C Vitiello
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. Università Cattolica del Sacro Cuore, Roma, Italia
| | - A Leone
- Department of Radiology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy. Università Cattolica del Sacro Cuore, Roma, Italia
| | - F Liuzza
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italia
| | - G Maccauro
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italia
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Hsu CL, Yang JJ, Yeh TT, Shen HC, Pan RY, Wu CC. Early fixation failure of locked plating in complex distal femoral fractures: Root causes analysis. J Formos Med Assoc 2020; 120:395-403. [PMID: 32586721 DOI: 10.1016/j.jfma.2020.06.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 06/06/2020] [Accepted: 06/14/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND/PURPOSE Orthopaedic Trauma Association (OTA) C-type distal femoral fractures can be very challenging to treat effectively. While locked plating is widely used in the complex distal femoral fracture, failure of locked plate fixation is not uncommon. First, we tried to determine the risk factor related to early failure of multiplanar OTA C-type fracture in the distal femur after fixation with lateral locked plate. Second, we tried to provide a strategy for surgeons to prevent pitfalls of early failure in the complex distal femoral fractures treated with lateral locked plating. METHODS We retrospectively reviewed 44 adults with OTA C-type fractures of the distal femur treated with locked plate fixation between 2010 and 2016 at Tri-Service General Hospital. Average length of follow-up was 27.6 months (range, 12-54 months). Univariate and multivariate logistic regression were used to determine the association of variables on early failure of fixation. A p-value < 0.05 in univariate and multivariate analyses were considered significant. RESULTS There were six patients experiencing early failure, and the early failure rate was 13.6%. The risk factors associated with early failure of complex distal femoral fracture identified by univariate analysis included sagittal oblique fracture pattern, longer working length and post-operative sagittal malalignment (odds ratio [OR] and 95% confidence intervals [CI]: 90.00 (6.85-1183.33), 0.55 (0.31-0.98) and 8.63 (1.077-69.075) respectively). The multivariate analysis showed only sagittal oblique fracture pattern was associated with early failure [OR: 52.348 (3.06-895.23)]. CONCLUSION Sagittal oblique fracture was more likely to result in early postoperative failure. Early recognition of the fracture pattern should be considered to avoid catastrophic results.
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Affiliation(s)
- Chun-Liang Hsu
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325, Cheng-Gong Road, Section 2, Taipei, 114, Taiwan, Republic of China.
| | - Jui-Jung Yang
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325, Cheng-Gong Road, Section 2, Taipei, 114, Taiwan, Republic of China.
| | - Tsu-Te Yeh
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325, Cheng-Gong Road, Section 2, Taipei, 114, Taiwan, Republic of China.
| | - Hsain-Chung Shen
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325, Cheng-Gong Road, Section 2, Taipei, 114, Taiwan, Republic of China.
| | - Ru-Yu Pan
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325, Cheng-Gong Road, Section 2, Taipei, 114, Taiwan, Republic of China.
| | - Chia-Chun Wu
- Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325, Cheng-Gong Road, Section 2, Taipei, 114, Taiwan, Republic of China.
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Radiographic and Clinical Outcomes of Periprosthetic Distal Femur Fractures Treated With Open Reduction Internal Fixation. J Orthop Trauma 2018; 32:515-520. [PMID: 30247279 DOI: 10.1097/bot.0000000000001265] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To report outcomes and complications of periprosthetic distal femur fractures (PPDFF) treated with open reduction internal fixation (ORIF) using a plate construct, with or without endosteal augmentation. DESIGN Retrospective Case Series. SETTING One Level I trauma center and one tertiary care hospital. PATIENTS/PARTICIPANTS Forty patients with PPDFFs, treated by 3 surgeons, were identified using an institutional trauma registry. Thirty-two patients with 12 months of clinical and radiographic follow-up were included, and 8 patients were lost to follow-up before 12 months. INTERVENTION All patients underwent ORIF of the PPDFF with lateral locked plating, and 11 received additional endosteal augmentation using allograft fibula. RESULTS Thirty-two patients were available for the final follow-up. Ninety-four percent of patients achieved union at an average of 6.5 months postoperatively. Twenty-one percent of patients underwent subsequent surgery, with more than half of those being for removal of implants. Anatomic limb alignment was achieved in all cases (no malunions). Almost half of the patients required assistive devices for ambulation in the long term. CONCLUSIONS ORIF of PPDFF with direct visualization using periarticular locking plates ± endosteal strut allograft resulted in a 94% union rate and no deep infections. There was no difference in outcomes between groups treated with or without additional endosteal fibular allograft. However, these are catastrophic injuries in frail patients, and 20% of patients either died or were lost to follow-up, and almost half required an assistive device for ambulation after surgery despite restoration of limb alignment. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Dang KH, Armstrong CA, Karia RA, Zelle BA. Outcomes of distal femur fractures treated with the Synthes 4.5 mm VA-LCP Curved Condylar Plate. INTERNATIONAL ORTHOPAEDICS 2018; 43:1709-1714. [PMID: 30267242 DOI: 10.1007/s00264-018-4177-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Given the recent controversy in the literature and the alarming reports of early mechanical failure associated with the use of the Synthes 4.5 mm VA-LCP Curved Condylar Plate in acute distal femur fractures, the goal of our study was to examine the outcomes and mechanical failure rates of this implant in a larger patient population. METHODS Patients 18 years of age and older who underwent plate fixation of their acute distal femoral fracture using the Synthes 4.5 mm VA-LCP Curved Condylar Plate were included in this retrospective study. The study data was collected through a retrospective chart review and review of the existing radiographic studies. Primary outcome measure was mechanical hardware failure while secondary outcome measures included nonunion, malunion, and medical and surgical complications. RESULTS A total of 74 patients (77 fractures) were included in this study. The fractures were classified according to the OTA/AO classification as 33-A2 (n = 6), 33-A3 (n = 19), 33-C1 (n = 5), 33-C2 (n = 25), and 33-C3 (n = 22). Thirty-two out of 77 fractures presented as open fractures (41.6%). A mechanical failure was observed in 7 patients (9.1%). Twenty additional patients needed a re-operation of the surgical site including two nonunion repairs, one malunion repair, 15 staged treatments of traumatic segmental bone defects, and two soft tissue debridements. CONCLUSIONS In our experience, the Synthes 4.5 mm VA-LCP Curved Condylar Plate is a safe and effective implant with a relatively low mechanical failure rate.
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Affiliation(s)
- Khang H Dang
- Department of Orthopaedics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA
| | - Connor A Armstrong
- Department of Orthopaedics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA
| | - Ravi A Karia
- Department of Orthopaedics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA
| | - Boris A Zelle
- Department of Orthopaedics, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, MC-7774, San Antonio, TX, 78229, USA.
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Fixation of periprosthetic or osteoporotic distal femoral fractures with locking plates: a pilot randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2018; 43:1193-1204. [PMID: 30069590 PMCID: PMC6470115 DOI: 10.1007/s00264-018-4061-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 07/12/2018] [Indexed: 12/13/2022]
Abstract
Introduction We hypothesised that the use of a polyaxial locking plate design offers the same clinical benefits as a monoaxial locking plate system following distal femoral osteoporotic/periprosthetic fracture fixation. Method A multicentre prospective randomised pilot trial was conducted. Inclusion criteria were patients over 60 years with a displaced osteoporotic or periprosthetic distal femoral fracture. Details documented included time to union, complications, reinterventions and functional outcomes according to the Oxford knee score and EuroQol EQ-5D. Analysis of factors influencing an early fracture healing response was performed between those with clear features of radiological callus formation at three months. Statistical analysis was performed using a logistic regression model with multiple covariates assessed for each plate system (1:1 ratio) over a follow-up period of one year. Results Forty patients (34 females) with a mean age of 77 (60–99) were recruited. Four patients deceased within the first six months. Twenty-five patients united by the six month follow-up. Six more patients progressed to union between six and nine months. Five patients developed non-union (two patients had implant failure; one in each group) and all underwent revision surgery. Malunion was evident in two cases, one with 15° of valgus (monoaxial plate), and one with 12° of recurvatum (polyaxial plate). Between the two plate systems, statistical analysis revealed no significant differences in most of the recorded parameters. Radiological features of early bone healing were present when the surgical approach was smaller (p = 0.015), and when a greater working length of the bridging plate was present (p = 0.016). Conclusion Both plate systems demonstrated good union rates and limited implant related complications. Good reduction, mechanically sound construct and respect of the local fracture biology was more important than the particular plate design characteristics. Electronic supplementary material The online version of this article (10.1007/s00264-018-4061-1) contains supplementary material, which is available to authorized users.
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Moloney GB, Pan T, Van Eck CF, Patel D, Tarkin I. Geriatric distal femur fracture: Are we underestimating the rate of local and systemic complications? Injury 2016; 47:1732-6. [PMID: 27311551 DOI: 10.1016/j.injury.2016.05.024] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/25/2016] [Accepted: 05/16/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Low energy distal femur fractures often occur in a fragile elderly population that is prone to local and systemic complications following operative treatment of extremity fractures. The nonunion rate and early complication rate following laterally based locked plating in this specific fracture are not well described. METHODS We conducted a retrospective cohort study conducted at three affiliated tertiary care hospitals to evaluate nonunion, early post operative complications, discharge disposition, length of stay, and mortality in patients over 60 years old undergoing laterally based locked plating of a low energy distal femur fracture. RESULTS Forty-four out of 176 patients were deceased at one year (25%). Predictors of one year mortality included older age, higher Charlson Comorbidity Index (CCI), and delay to surgery greater than 2days (p<0.001). Of 99 patients alive and with follow up at one year, 24 (24%) developed a nonunion and 21 of 24 required nonunion surgery. Development of a surgical site infection was statistically significantly correlated with development of nonunion. Age and CCI did not predict development of nonunion. Average length of stay was 10days and 82% of patients were discharged to a skilled nursing facility. Thirty eight percent of patients experienced at least one postoperative systemic complication. CONCLUSIONS Laterally based locked plating of the low energy geriatric distal femur fracture is most often followed by a tumultuous post-operative course with a high rate of local and systemic complications including death, nonunion, and extended hospital stays. LEVEL OF EVIDENCE Level III prognostic.
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Affiliation(s)
- Gele B Moloney
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, United States.
| | - Tiffany Pan
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, United States.
| | - Carola F Van Eck
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, United States.
| | - Devan Patel
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, United States.
| | - Ivan Tarkin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Kaufmann Building, Suite 911, 3471 Fifth Avenue, Pittsburgh, PA, United States.
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Abstract
OBJECTIVES To document the high failure rate of a specific implant: the Synthes Variable Angle (VA) Locking Distal Femur Plate. DESIGN Retrospective. SETTING Urban University Level I Trauma Center. PATIENT/PARTICIPANTS All distal femur fractures (OTA/AO 33-A, B, C) treated from March 2011 through August 2013 were reviewed from our institutional orthopaedic trauma registry. Inclusion criteria were fractures treated with a precontoured distal femoral locking plate and age between 18 and 84. Exclusion criteria were fractures treated with intramedullary nails, arthroplasty, non-precontoured plates, dual plating, or screw fixation alone. The population was divided into 3 groups: less invasive stabilization system (LISS) group (n = 21), treated with LISS plates (Synthes, Paoli, PA); locking condylar plates (LCPs) group (n = 10), treated with LCPs (Synthes, Paoli, PA); and VA group (n = 36), treated with VA distal femoral LCPs (Synthes, Paoli, PA). Average age was 54.6 ± 17.5 years. INTERVENTION Open reduction internal fixation with one of the above implants was performed. MAIN OUTCOME MEASURES The patients were followed radiographically for early mechanical implant failure defined as loosening of locking screws, loss of fixation, plate bending, or implant failure. RESULTS There were no statistically significant differences between groups for age, gender, open fracture, mechanism of injury, or medial comminution. There were 3 failures (14.3%) in group LISS, no failures (0%) in group LCP, and 8 failures (22.2%) in group VA. All 3 failures in group LISS were in A-type fractures (2 periprosthetic) and all failures in group VA were in C-type fractures. When all fractures for all 3 groups were compared for failure rate, there was no statistically significant difference (P = 0.23). However, when only 33-C fractures were compared, there was significantly greater failure rate in the VA group (P = 0.03). The mean time to failure in group VA was 147 days (range 24-401 days) and was significantly earlier (P = 0.034) when compared with group LISS (mean 356 days; range 251-433 days). CONCLUSIONS Early mechanical failure with the VA distal femoral locking plate is higher than traditional locking plates (LCP and LISS) for OTA/AO 33-C fractures. We caution practicing surgeons against the use of this plate for metaphyseal fragmented distal femur fractures. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Kazemi SM, Minaei R, Safdari F, Keipourfard A, Forghani R, Mirzapourshafiei A. Supracondylar Osteotomy in Valgus Knee: Angle Blade Plate Versus Locking Compression Plate. THE ARCHIVES OF BONE AND JOINT SURGERY 2016; 4:29-34. [PMID: 26894215 PMCID: PMC4733232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 11/22/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND There are few studies comparing the biomechanical properties of angled blade plate and locking compression plates in supracondylar osteotomy. In the current randomized study, we prospectively compared the clinical and radiological outcomes of supracondylar osteotomy using these two plates. METHODS Forty patients with valgus knee malalignment were randomly assigned to two equal numbered groups: angled blade plate and locking compression plates. All of the patients underwent medial closing wedge supracondylar osteotomy and were followed for one year. Before and after the operation the valgus angle and mechanical lateral distal femoral angle were compared between groups. Also, the rate of complications were compared. RESULTS After the operation, the mean valgus angle and mechanical lateral distal femoral angle improved significantly in the two groups (P<0.001). Although, the preoperative amount of the valgus angle and mechanical lateral distal femoral angle were the same, at the last visit the valgus angle (5.4±2.1 versus 3.1±1.8; P=0.032) and mechanical lateral distal femoral angle (87.6±2 versus 89.7±3.2; P=0.041) were significantly lower and higher in the angled blade plate group, respectively. Nonunion occurred in four patients (20%) in the locking compression plates group (P=0.35). CONCLUSION Based on having a larger valgus angle and mechanical lateral distal femoral angle correction in the angled blade plate group and considerable rate of nonunion in the locking compression plate group, the authors recommend using the angled blade plate for fixation of medial closing wedge supracondylar osteotomy for patients with valgus malalignment. However, more long-term studies are required.
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Affiliation(s)
- Seyyed Morteza Kazemi
- Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Minaei
- Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshad Safdari
- Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Keipourfard
- Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rozhin Forghani
- Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alemeh Mirzapourshafiei
- Bone Joint and Related Tissue Research Center, Akhtar Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Lampropoulou-Adamidou K, Tosounidis TH, Kanakaris NK, Ekkernkamp A, Wich M, Giannoudis PV. The outcome of Polyax Locked Plating System for fixation distal femoral non-implant related and periprosthetic fractures. Injury 2015; 46 Suppl 5:S18-24. [PMID: 26343298 DOI: 10.1016/j.injury.2015.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The objective of this study was to report on the safety, efficacy and clinical outcomes of the Polyax Locked Plating System (Biomet, Warsaw, IN, USA) in the management of acute (non-implant related and periprosthetic) distal femoral fractures. We retrospectively reviewed 71 patients with 73 distal femoral fractures. Thirty-three of the included fractures occurred around previously placed implants. The average patients' age was 67 years (range 18-98). There were 7 early postoperative complications (9.5%) including one deep surgical site infection, 2 pulmonary embolisms and 4 urinary or respiratory infections. At final follow-up (mean 12, range 9-55 months) all fractures progressed to clinical and radiological union. However, major revision surgery for healing problems was required in 5 cases (6.8%) and minor in 3 cases (4.1%). The average time to healing was 6 (range 3-23) months. Angulation less than 5 degrees in any plane was observed in 66 cases (89.7%), within 5-10 degrees in 5 cases (7.3%) and within 10-15 degrees in 2 cases (2.9%). The mean pre-injury and final follow-up values of Glasgow Outcome Scale were 1.5(1-3) and 1.7(1-3) respectively. Overall 61 patients (83.53%) retained their pre-injury activity status. The Polyax Locked Plating System offers a safe and efficient fixation in distal femoral fractures.
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Affiliation(s)
- Kalliopi Lampropoulou-Adamidou
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK
| | - Theodoros H Tosounidis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, West Yorkshire, LS7 4SA Leeds, UK
| | - Nikolaos K Kanakaris
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK
| | - Axel Ekkernkamp
- Department of Trauma and Orthopedic Surgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany
| | - Michael Wich
- Department of Trauma and Orthopedic Surgery, Unfallkrankenhaus Berlin, Warener Str. 7, 12683 Berlin, Germany; Klinikum Dahme-Spreewald, Koepenicker Str. 29, 15711 Koenigs Wusterhausen, Germany
| | - Peter V Giannoudis
- Academic Department of Trauma & Orthopaedic Surgery, University of Leeds, Clarendon Wing, Floor A, Great George Street, Leeds General Infirmary, LS1 3EX Leeds, UK; NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, West Yorkshire, LS7 4SA Leeds, UK.
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Gee CW, Dahal L, Rogers BA, Harry LE. Ankle fractures in the elderly: an overlooked burden. Br J Hosp Med (Lond) 2015; 76:564-9. [PMID: 26457936 DOI: 10.12968/hmed.2015.76.10.564] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ankle fractures in the elderly are a complex under-recognized burden which require a multidisciplinary approach to management. This article discusses the holistic approach required, including the up-to-date surgical management options and the areas for future development.
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Affiliation(s)
- Christopher W Gee
- ST5 in Trauma and Orthopaedics in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Brighton, East Sussex BN2 5BE
| | - Luna Dahal
- 4th Year Medical Student, Brighton and Sussex Medical School, Brighton
| | - Benedict A Rogers
- Consultant Trauma and Orthopaedic Surgeon in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust and Honorary Senior Lecturer at Brighton and Sussex Medical School, Brighton
| | - Lorraine E Harry
- Consultant Orthoplastic Surgeon in the Department of Trauma and Orthopaedics, Brighton and Sussex University Hospitals NHS Trust and Queen Victoria Hospital NHS Foundation Trust, East Grinstead
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Affiliation(s)
- Michael Bottlang
- Biomechanics Laboratory, Legacy Research Institute, Portland, OR 97232, USA.
| | - Peter Augat
- Institute of Biomechanics, Trauma Center Murnau, Prof.-Kuentscher-Str. 8, 82418 Murnau, Germany; Institute of Biomechanics, Paracelsus Medical University Salzburg, Strubergasse 21, Salzburg, Austria.
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