Flexible internal fixation with locking plate for distal femoral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Jun , YIN Weizhong , QIU Yongmin , SHEN Yanguo , CAO Shifeng ,  WANG Jian

Department of Orthopaedics, Shanghai Pudong New Area People’s Hospital, Shanghai, 201299, P.R.China;

Corresponding author：

WANG Jian, Email: wjwj0328@163.com

Keywords：

Distal femoral fracture; locking plate; internal fixation

DOI：

10.7507/1002-1892.201707117

Video：

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Objective To analyze the effectiveness of flexible internal fixation with locking plate for distal femoral fractures. Methods Between January 2015 and June 2016, 21 cases of distal femoral fractures were treated. There were 5 males and 16 females with an average age of 62 years (range, 32-88 years). Injury was caused by falling in 14 cases, by traffic accident in 5 cases, and by falling from height in 2 cases. The fractures located at the left side in 13 cases and the right side in 8 cases. Twenty cases were fresh closed fractures and 1 case was open fracture. According to AO/Association for the Study of Internal Fixation (AO/OTA) typing, there were 5 cases of type 33-A1, 3 of type 33-A2, 8 of type 33-A3, 2 of type 33-C2, and 3 of type 33-C3. The time from injury to operation was 3-13 days (mean, 6.5 days). Results All operation incisions healed primarily. Eighteen patients were followed up 12-24 months (mean, 16 months). All fractures healed, and the healing time was 8-24 weeks (mean, 16.6 weeks). The articular surface was smooth and the thigh length was recovered. No screw loosening, plate breakage, valgus or varus of the knee, stiff of the knee or non-unions occurred during follow-up. There was no significant difference in visual analogue scale (VAS) score between at 6 and 12 months after operation (P>0.05), and the difference was significant bewteen the other time points (P<0.05). There were significant differences in the range of motion of knee between 1 month and 3, 6, 12 months (P<0.05); there was no significant difference between 3, 6, and 12 months (P>0.05). There were significant differences in the Neer scores between 1, 3, 6, and 12 months after operation (P<0.05). According to Neer score criteria, the results were excellent in 12 cases and good in 6 cases at 12 months after operation. Conclusion Flexible internal fixation with locking plate for distal femoral fractures can get good functional recovery.

Citation： ZHANG Jun, YIN Weizhong, QIU Yongmin, SHEN Yanguo, CAO Shifeng, WANG Jian. Flexible internal fixation with locking plate for distal femoral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 36-39. doi: 10.7507/1002-1892.201707117 Copy

1.	Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification ompendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(suppl 10): S1-S133.
2.	Court-Brown CM, Caesar B. Epidemiology of adult fracture: A review. Injury, 2006, 37(8): 691-697.
3.	Rodriguez EK, Boulton C, Weaver MJ, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury, 2014, 45(3): 554-559.
4.	Hoffmann MF, Jones CB, Sietsema DL, et al. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res, 2013, 8: 43.
5.	金京日, 任红革, 刘彦群, 等. 膝前切口经髌骨纵行截骨入路治疗股骨远端 C 型骨折的疗效分析. 中国修复重建外科杂志, 2015, 29(6): 700-703.
6.	Henderson CE, Kuhl LL, Fitzpatrick DC, et al. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma, 2011, 25 Suppl 1: S8-S14.
7.	Bottlang M, Doornink J, Lujan TJ, et al. Effects of construct stiffness on healing of fractures stabilized with locking plates. J Bone Joint Surg (Am), 2010, 92 Suppl 2: 12-22.
8.	Lujan TJ, Henderson CE, Madey SM, et al. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma, 2010, 24(3): 156-162.
9.	Gardner MJ, Nork SE, Huber P, et al. Less rigid stable fracture fixation in osteoporotic bone using locked plates with near cortical slots. Injury, 2010, 41(6): 652-656.
10.	Plecko M, Lagerpusch N, Andermatt D, et al. The dynamisation of locking plate osteosynthesis by means of dynamic locking screws (DLS)-an experimental study in sheep. Injury, 2013, 44(10): 1346-1357.
11.	Neer CS 2nd, Grantham SA, Shelton ML. Supracondylar fracture of the adult femur. A study of one hundred and ten cases. J Bone Joint Surg (Am), 1967, 49(4): 591-613.
12.	Hanschen M, Aschenbrenner IM, Fehske K, et al. Mono-versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial. Int Orthop, 2014, 38(4): 857-863.
13.	Ricci WM, Streubel PN, Morshed S, et al. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 305 cases. J Orthop Trauma, 2014, 28(2): 83-89.
14.	Smith TO, Hedges C, MacNair R, et al. The clinical and radiological outcomes of the LISS plate for distal femoral fractures: a systematic review. Injury, 2009, 40(10): 1049-1063.
15.	Sellei RM, Garrison RL, Kobbe P, et al. Effects of near cortical slotted holes in locking plate constructs. J Orthop Trauma, 2011, 25 Suppl 1: S35-S40.
16.	Linn MS, McAndrew CM, Prusaczyk B, et al. Dynamic Locked Plating of Distal Femur Fractures. J Orthop Trauma, 2015, 29(10): 447-450.
17.	Bottlang M, Fitzpatrick DC, Sheerin D, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma, 2014, 28(4): 181-188.
18.	Oh JK, Hwang JH, Lee SJ, et al. Dynamization of locked plating on distal femur fraeture. Arch Orthop Trauma Surg, 2011, 131(4): 535-539.
19.	高哲辰, 周方, 田耘, 等. 锁定接骨板内固定治疗股骨远端骨折. 中华创伤骨科杂志, 2016, 18(11): 965-969.

1. Marsh JL, Slongo TF, Agel J, et al. Fracture and dislocation classification ompendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma, 2007, 21(suppl 10): S1-S133.
2. Court-Brown CM, Caesar B. Epidemiology of adult fracture: A review. Injury, 2006, 37(8): 691-697.
3. Rodriguez EK, Boulton C, Weaver MJ, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury, 2014, 45(3): 554-559.
4. Hoffmann MF, Jones CB, Sietsema DL, et al. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res, 2013, 8: 43.
5. 金京日, 任红革, 刘彦群, 等. 膝前切口经髌骨纵行截骨入路治疗股骨远端 C 型骨折的疗效分析. 中国修复重建外科杂志, 2015, 29(6): 700-703.
6. Henderson CE, Kuhl LL, Fitzpatrick DC, et al. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma, 2011, 25 Suppl 1: S8-S14.
7. Bottlang M, Doornink J, Lujan TJ, et al. Effects of construct stiffness on healing of fractures stabilized with locking plates. J Bone Joint Surg (Am), 2010, 92 Suppl 2: 12-22.
8. Lujan TJ, Henderson CE, Madey SM, et al. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma, 2010, 24(3): 156-162.
9. Gardner MJ, Nork SE, Huber P, et al. Less rigid stable fracture fixation in osteoporotic bone using locked plates with near cortical slots. Injury, 2010, 41(6): 652-656.
10. Plecko M, Lagerpusch N, Andermatt D, et al. The dynamisation of locking plate osteosynthesis by means of dynamic locking screws (DLS)-an experimental study in sheep. Injury, 2013, 44(10): 1346-1357.
11. Neer CS 2nd, Grantham SA, Shelton ML. Supracondylar fracture of the adult femur. A study of one hundred and ten cases. J Bone Joint Surg (Am), 1967, 49(4): 591-613.
12. Hanschen M, Aschenbrenner IM, Fehske K, et al. Mono-versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial. Int Orthop, 2014, 38(4): 857-863.
13. Ricci WM, Streubel PN, Morshed S, et al. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 305 cases. J Orthop Trauma, 2014, 28(2): 83-89.
14. Smith TO, Hedges C, MacNair R, et al. The clinical and radiological outcomes of the LISS plate for distal femoral fractures: a systematic review. Injury, 2009, 40(10): 1049-1063.
15. Sellei RM, Garrison RL, Kobbe P, et al. Effects of near cortical slotted holes in locking plate constructs. J Orthop Trauma, 2011, 25 Suppl 1: S35-S40.
16. Linn MS, McAndrew CM, Prusaczyk B, et al. Dynamic Locked Plating of Distal Femur Fractures. J Orthop Trauma, 2015, 29(10): 447-450.
17. Bottlang M, Fitzpatrick DC, Sheerin D, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma, 2014, 28(4): 181-188.
18. Oh JK, Hwang JH, Lee SJ, et al. Dynamization of locked plating on distal femur fraeture. Arch Orthop Trauma Surg, 2011, 131(4): 535-539.
19. 高哲辰, 周方, 田耘, 等. 锁定接骨板内固定治疗股骨远端骨折. 中华创伤骨科杂志, 2016, 18(11): 965-969.

Chinese Journal of Reparative and Reconstructive Surgery

Flexible internal fixation with locking plate for distal femoral fractures

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