Surgical treatment of distal femoral fractures using a distal femoral locked plate versus a condylar buttress plate

Abstract Background The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated. Methods A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020. Results Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%). Conclusions The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation. Level of evidence IV.

Download Full-text

Early Surgery Does Not Improve Outcomes for Patients with Periprosthetic Femoral Fractures—Results from the Registry for Geriatric Trauma of the German Trauma Society

Medicina ◽

10.3390/medicina57060517 ◽

2021 ◽

Vol 57 (6) ◽

pp. 517

Author(s):

Christopher Bliemel ◽

Katherine Rascher ◽

Tom Knauf ◽

Juliana Hack ◽

Daphne Eschbach ◽

...

Keyword(s):

Surgical Treatment ◽

Mortality Rate ◽

Femoral Fractures ◽

Geriatric Trauma ◽

Outcome Parameters ◽

Periprosthetic Femoral Fractures ◽

Trauma Society ◽

Eq5d Index ◽

Early Surgical Treatment

Background and Objectives: Appropriate timing of surgery for periprosthetic femoral fractures (PFFs) in geriatric patients remains unclear. Data from a large international geriatric trauma register were analyzed to examine the outcome of patients with PFF with respect to the timing of surgical stabilization. Materials and Methods: The Registry for Geriatric Trauma of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie (DGU)) (ATR-DGU) was analyzed. Patients treated surgically for PFF were included in this analysis. As outcome parameters, in-house mortality rate and mortality at the 120-day follow-up as well as mobility, the EQ5D index score and reoperation rate were analyzed in relation to early (<48 h) or delayed (≥48 h) surgical stabilization. Results: A total of 1178 datasets met the inclusion criteria; 665 fractures were treated with osteosynthesis (56.4%), and 513 fractures were treated by implant change (43.5%). In contrast to the osteosynthesis group, the group with implant changes underwent delayed surgical treatment more often. Multivariate logistic regression analysis of mortality rate (p = 0.310), walking ability (p = 0.239) and EQ5D index after seven days (p = 0.812) revealed no significant differences between early (<48 h) and delayed (≥48 h) surgical stabilization. These items remained insignificant at the follow-up as well. However, the odds of requiring a reoperation within 120 days were significantly higher for delayed surgical treatment (OR: 1.86; p = 0.003). Conclusions: Early surgical treatment did not lead to decreased mortality rates in the acute phase or in the midterm. Except for the rate of reoperation, all other outcome parameters remained unaffected. Nevertheless, for most patients, early surgical treatment should be the goal, so as to achieve early mobilization and avoid secondary nonsurgical complications. If early stabilization is not possible, it can be assumed that orthogeriatric co-management will help protect these patients from further harm.

Download Full-text

Double plating of intra-articular multifragmentary C3-type distal femoral fractures through the anterior approach

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-017-2014-9 ◽

2017 ◽

Vol 28 (1) ◽

pp. 121-130 ◽

Cited By ~ 10

Author(s):

Mohamed A. Imam ◽

Ahmed Torieh ◽

Ahmed Matthana

Keyword(s):

Anterior Approach ◽

Femoral Fractures ◽

Distal Femoral Fractures ◽

Double Plating

Download Full-text

FUNCTIONAL OUTCOME OF DISTAL FEMORAL FRACTURES AND THEIR MANAGEMENT

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v5i6.1930 ◽

2021 ◽

Vol 5 (6) ◽

Author(s):

Raman Shrivastava ◽

Namita Shrivastava

Keyword(s):

Functional Outcome ◽

Surgical Techniques ◽

Femoral Fractures ◽

Railway Track ◽

Distal Femoral Fractures ◽

Minimally Invasive Surgical ◽

Fall From Height ◽

Classification Management ◽

A Prospective Study ◽

Jawaharlal Nehru

Background: Fractures of distal end of femur are complex injuries which are difficult to manage. These fractures often are unstable and comminuted. Despite advances in surgical techniques and improvement in implants, treatment of distal femoral fractures remains a challenge in many situations. This study was done to analyse the functional outcome and this management of distal femoral fractures. Material & Methods: This study has been done between August 2008 to March 2010 on patients coming to Orthopaedics Department at Jawaharlal Nehru Hospital and Research Center, Bhilai. It is a prospective study which includes 25 patients with 10 Type A, 7 Type B and 8 Type C fractures of distal femur after fulfilling the inclusion and exclusion criteria. Results: Mean age of 47.08 years with sex incidence of 3.17:1(M:F). Mode of injury was RTA in 16, simple fall in 6, fall from height in 2 and railway track accident in 1 patient. There were 5-A1, 1-A2, 4-A3, 3-B1, 1-B2, 3-B3, 1-C1, 4-C2 and 3-C3 fractures. Results were found to be excellent in 17, good in 1, moderate in 3 and poor in 4 patients. Conclusion: We conclude that minimally invasive surgical techniques and with the availability of locking type of plates distal femoral fractures can now be dealt with more precessions and more satisfactory results can be produced. Keywords: Distal fractures, Muller Classification, Management, Femoral fractures

Download Full-text