DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20160343

Utility and outcomes of locking compression plates in distal femoral fractures

Shriharsha R.V., Sapna M

Abstract


Background: Supracondylar and intercondylar fractures of femur present a huge surgical challenge. The purpose of this study was to evaluate the rate of union, functional outcome and complications of these fractures treated with open reduction and internal fixation with a locking compression plate- distal femur (LCP-DF).

Methods: A prospective study of 26 fractures in 25 patients was done during a period of June 2012 to July 2014. Based on clinical diagnosis and x rays, the fractures were managed by surgery and had a minimum follow up of one year. The decision to fix with Locking compression plates was taken based on extensive comminution, missing bone, poor quality of bone and a combination of these factors. Primary Bone grafting was done in cases of severe medial comminution.

Results: Overall 26 fractures were studied. The mean age was 44 yrs. Out of 25 patients, 16/25(64%) were men and 36% were women. There were 10/26 type A and 16/26 type C fractures. There were 57.6% closed fractures and 42.3 % open fractures. Bone grafting was done for 13 fractures. The average time for union in open fractures was 20.60 weeks and 18.53 weeks for closed fractures. The average range of motion for closed fractures was 10- 100.330 and for open fractures was 50- 84.50The results of entire study group showed 4 excellent, 10 good, 5 fair and 6 poor. We saw that 2 of 10 (20%) open fractures had excellent or good results whereas 12 of 15(80%) closed fractures had excellent or good results (p <0.005). The 8 of 10(80%) type A fractures had excellent or good results whereas 6 of 15(40%) type C fractures had excellent or good results (p<0.058). The closed fractures united early as compared to open fractures (p <0.72). The closed fractures had a mean range of 99 degrees movement against the open fractures which had 79 degrees (p <0.36). the type A fractures had a better range of movement( 106 degrees) as compared to type C fractures(81.67 degrees) (p <0.13).

Conclusions: Locking compression plates had better outcome in closed fractures than open fractures. The extra articular (type A) fractures had better outcome than intra articular (type C) fractures. The closed fractures united earlier as compared to open fractures. There was no significant difference in time of union in fractures where bone graft was used and in those where no bonegraft was used. Knee stiffness is a common complication following these fractures. Therefore the distal femoral LCP provides a stable fixation in comminuted fractures.

Keywords


Distal femur fracture, Locking compression plates, Outcome

Full Text:

PDF

References


Kiran kumar GN, Sharma G, Farooque K, Sharma V. Locking compression plate in distal femoral intra articular fractures: our experience. International scholarly research, 2014. Article id 372916.

Hoffmann MF, Jones CB, Sietsema DL. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. Journal of orthopedic surgery and research. 2013;8:43.

Yeap EJ, Deepak AS. Distal Femoral Locking Compression Plate Fixation in Distal.

Femoral Fractures. Early Results Malaysian Orthopaedic Journal. 2007;1(1).

Parker DA, Lautenschlager EP, Caravelli ML, Flanigan DC, Merk BR. A Biomechanical Comparison of Distal Femoral Fracture Fixation: The Dynamic Condylar Screw, Distal Femoral Nail, Locking Condylar Plate, and Less Invasive Stabilization System. OTA, 2005.

Krettek C, Muller M, Miclau T. Evolution of Minimally Invasive Plate Osteosynthesis (MIPO) in the femur. Injury. 2001;3:14-23.

Krettek C, Schandelmaier P, Miclau T. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury. 1997;28:20-30.

Kubiak EN, Fulkerson E, Strauss E, Egol KA. Evolution of Locked Plates. The Journal of Bone and Joint Surgery. 2006;88:189-200.

Giles JB, Delee JC, Heckman JD. Supracondylar - intercondylar fractures of the femur treated with a supracondylar plate and lag screw. J Bone Joint Surg Am. 1982;64:864-70.

Brown A, D'Arcy JC. Internal fixation for supracondylar fractures of the femur in the elderly patient .J Bone Joint Surg Br. 1971;53-B:420-4.

Ahmad M, Nanda R, Bajwa AS, Candal-Couto J, Green S, Hui AC. Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability? Injury. 2007;38(3):358-64.

Parker DA, Lautenschlager EP, Caravelli ML, Flanigan DC, Merk BR. A Biomechanical Comparison of Distal Femoral Fracture Fixation: The Dynamic Condylar Screw, Distal Femoral Nail, Locking Condylar Plate, and Less Invasive Stabilization System. OTA, 2005.

Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18(8):488-93.

Bell KM, Johnstone AJ, Court Brown CM, Hughes SP: J Bone Joint surg Br. 1992;74:400-02.

Healy WL, Siliski JM, Incavo SJ. Operative treatment of distal femoral fractures proximal to total knee replacements. J Bone Joint Surg Am. 1993;75:27-34.

Seinsheimer F. Fractures of the distal femur. Clin Orthop Relat Res. 1980;153:169-79.

Neer CS, Grantham SA, Shelton ML. Supracondylar fracture of the adult femur. J Bone Joint Surg Am. 1967,49:591-613.

Siliski JM, Mahring M, Hofer HP. Supracondylar- Intercondylar fractures of femur. JBJS. 1989;71A:95-104.

Phipatanakul WP, Mayo KA, Mast JW, Bolhofner BR. Reconstruction of the Distal Femur with Use of a New Device: The Locking Condylar Plate. OTA. 2001.

Phipatanakul WP, Mayo KA, Mast JW. Treatment of Distal Femur Fractures with New Device; The Locking Condylar Plate. OTA, 2005.