Clinical effect of locking compression plate via posterolateral approach in the treatment of distal femoral fractures: a new approach

Comprehensive Review on Distal Femur Fractures: From Epidemiology to Treatment Strategies

Distal femur fractures present a substantial orthopedic challenge, necessitating a comprehensive exploration spanning epidemiology, anatomy, classification, diagnosis, and treatment strategies. This review thoroughly analyzes the multifaceted aspects surrounding distal femur fractures. It delves into the definition and epidemiology, shedding light on the incidence, age distribution, and associated risk factors. An exhaustive examination of the distal femur's anatomy, encompassing ligaments and tendons, establishes the groundwork for understanding fracture patterns and subsequent classification according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) system. Diagnostic considerations encompass physical examination and various imaging modalities, emphasizing the critical importance of prompt and accurate assessment. The extensive discussion on treatment options ranges from non-surgical management, including casting and traction, to surgical interventions, such as open reduction and internal fixation, intramedullary nailing, and external fixation. The implications for clinical practice underscore the necessity for tailored approaches based on fracture characteristics to optimize patient outcomes. However, this review also emphasizes areas necessitating further investigation, including exploring predictive biomarkers, advanced surgical techniques, and innovative rehabilitation protocols. Insights from long-term outcomes and quality-of-life assessments in diverse populations offer promising avenues for enhancing the comprehensive management of distal femur fractures. Continuous research in these areas can refine treatment strategies and elevate the standard of care for individuals grappling with this intricate orthopedic condition.

Biomechanical evaluation of intramedullary retrograde nail and dynamic condylar screw used in unstable distal femoral fractures

Distal femur fractures are a common problem in orthopedics. Intramedullary retrograde nails (IRN) and dynamic condylar screws (DCS) are generally used for the treatment of these fractures. In this study, it was aimed to mechanically evaluate and compare these two implants used for the treatment of distal femur fractures. In this study, an AOOTA 33C1.3 fracture was created on the intact femur obtained from computed tomography images. The fractures were fixed with DCS and IRN. Then the created models were imported into the ANSYS Workbench for finite element analysis to determine the most convenient mechanical fixation type. The distal region of the femur was loaded considering 75 kg-f, and the created models were constrained in all directions from the femoral head. The intact femur was also analyzed to compare it with the DCS and IRN fixation models. The von Mises stress, strain, and displacement results were examined to determine the damage risk. According to the results, the risk of damage is lower in the model of fixation with IRN. The normal strain distribution in the model fixed with IRN is closer to the model of an intact femur. For this reason, the risk of stress shielding in IRN fixation is less than in DCS fixation. However, the fracture lines were more stable in the fixation with the DCS. In conclusion, fracture fixation with IRN is mechanically more suitable for distal femur fractures in terms of fracture healing.

Double plating via anterolateral and posterolateral approach for distal femoral fracture

Although there are some reports highlighting the applicability of double plates in distal femoral fractures, there is no standard approach or fixation method for supracondylar fractures combined with posterior coronal shear fractures. We report a case of distal femoral fracture treated with a lateral locking plate and posterior buttress plate using anterolateral and posterolateral approaches from one incision. A 70-year-old man was hit by a motorcycle and had an intra-articular distal femoral fracture involving a long medial proximal spike and a single lateral condyle fragment, with the lateral condyle fragment posteriorly displaced. A 12-cm lateral skin incision was made, and the joint was developed using a para-patellar approach from the anterior to iliotibial band. Posterior buttress plate fixation was successfully performed from behind the iliotibial band using a posterolateral approach, followed by cannulated cancellous screw and lateral locking plate fixation from the anterolateral window. Combined anterolateral and posterolateral approaches from one incision enable intra-articular exposure and fixation based on fixation principles for lateral condyle fragments combined with supracondylar fracture.

"Shimming a Plate" Technique to Correct the Coronal Malalignment in Metadiaphyseal Distal Femur Fracture: Case Report

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.

Femoral condylar locking compression plates: a case series. The Rural District General Hospital Experience

Most studies regarding the use of locking condylar plates in distal femoral fractures have been carried out in tertiary centres. The aim of this case series was to examine outcomes for patients managed in a rural setting and to answer the question: ‘should we be shipping these patients out to a regional trauma centre?’ Recent insertions of condylar locking compression plates (LCPs) at a rural district general hospital were examined. (All used the Synthes LCP Condylar Plate 4.5/5.0 periarticular plating system). Their clinical records and radiology were reviewed to identify failure rates and facilitate discussion of such cases. Of 36 reviewed cases, 4 instances of failure were identified (11%), and their cases are discussed individually herein. This review not only affords the opportunity to discuss cases of failure and to speculate upon their potential causes, but also highlights reassuringly high quality of outcomes for these patients outside of larger teaching hospitals.