Current status and progress of locking plate in the treatment of distal femoral comminuted fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SHI Jinyou ,  XIAO Yuzhou

Department of Orthopedics, the First Affiliated Hospital, Bengbu Medical College, Bengbu Anhui, 233000, P.R.China;

Corresponding author：

XIAO Yuzhou, Email: XiaoYuzhou1@aliyun.com

Keywords：

Distal femoral fracture; locking plate; micro-movement; biphasic plating; digital orthopedics

DOI：

10.7507/1002-1892.202102050

Video：

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Objective To review the current status and progress of locking plate for the treatment of distal femoral comminuted fractures.Methods The related literature was extensively reviewed to summarize the current status and progress in the treatment of distal femoral comminuted fracture with locking plate from four aspects: the current treatment situation, the shortcomings of locking plate and countermeasures, the progress of locking technology, locking plate and digital orthopedic technology.Results Treatment of distal femoral comminuted fractures is challenging. Locking plates, the most commonly used fixation for distal femoral comminuted fractures, still face a high rate of treatment failure. Double plates can improve the mechanical stability of comminuted fractures, but specific quantitative criteria are still lacking for when to choose double plates for fixation. The far cortial locking screw has shown good application value in improving the micro-movement and promoting the growth of callus. The biphasic plating is a development of the traditional locking plate, but needs further clinical examination. As an auxiliary means, digital orthopedic technology shows a good application prospect.Conclusion The inherent defect of locking plate is a factor that affects the prognosis of distal femoral comminuted fracture. The optimization of locking technology combined with digital orthopedic technology is expected to reduce the failure rate of treatment of distal femoral comminuted fracture.

Citation： SHI Jinyou, XIAO Yuzhou. Current status and progress of locking plate in the treatment of distal femoral comminuted fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(10): 1352-1356. doi: 10.7507/1002-1892.202102050 Copy

1.	鞠林林, 陈伟, 张奇, 等. 2010 年至 2011 年中国东部与西部地区成人股骨远端骨折的流行病学对比分析. 中华创伤骨科杂志, 2017, 19(5): 417-422.
2.	程家祥, 陈伟, 孙然, 等. 2003 年至 2012 年河北医科大学第三医院成人股骨远端骨折的流行病学分析. 中华创伤骨科杂志, 2014, 16(8): 695-699.
3.	Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop, 2018, 42(1): 191-196.
4.	Wolf O, Mukka S, Ekelund J, et al. How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11, 799 femoral fractures in the Swedish Fracture Register. Acta Orthop, 2021, 92(1): 40-46.
5.	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: S8-14.
6.	Hake ME, Davis ME, Perdue AM, et al. Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg, 2019, 27(19): e867-e875.
7.	DeKeyser GJ, Kellam PJ, Haller JM. Locked plating and advanced augmentation techniques in osteoporotic fractures. Orthop Clin North Am, 2019, 50(2): 159-169.
8.	Epari DR, Gurung R, Hofmann-Fliri L, et al. Biphasic plating improves the mechanical performance of locked plating for distal femur fractures. J Biomech, 2021, 115: 110192.
9.	Jain D, Arora R, Garg R, et al. Functional outcome of open distal femoral fractures managed with lateral locking plates. Int Orthop, 2020, 44(4): 725-733.
10.	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.
11.	Park KH, Oh CW, Park KC, et al. Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg, 2021, 141(2): 207-214.
12.	Sanders R, Swiontkowski M, Rosen H, et al. Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg (Am), 1991, 73(3): 341-346.
13.	Park KH, Oh CW, Park KC, et al. Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg, 2021, 141(2): 207-214.
14.	庄云强, 张亚弟, 张军, 等. 三种内固定方式治疗股骨远端 Müller 分型 C2 和 C3 型骨折的疗效比较. 中华创伤骨科杂志, 2020, 22(3): 238-242.
15.	Elkins J, Marsh JL, Lujan T, et al. Motion predicts clinical callus formation: Construct-specific finite element analysis of supracondylar femoral fractures. J Bone Joint Surg (Am), 2016, 98(4): 276-284.
16.	Perren SM. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orthop Relat Res, 1979, (138): 175-196.
17.	张俊, 邱永敏, 尹伟忠, 等. 单侧与双侧钢板治疗粉碎性股骨远端骨折的疗效比较. 生物骨科材料与临床研究, 2017, 14(1): 56-60.
18.	Bologna MG, Claudio MG, Shields KJ, et al. Dual plate fixation results in improved union rates in comminuted distal femur fractures compared to single plate fixation. J Orthop, 2019, 18: 76-79.
19.	Fontenot PB, Diaz M, Stoops K, et al. Supplementation of lateral locked plating for distal femur fractures: A biomechanical study. J Orthop Trauma, 2019, 33(12): 642-648.
20.	Lodde MF, Raschke MJ, Stolberg-Stolberg J, et al. Union rates and functional outcome of double plating of the femur: systematic review of the literature. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-03767-6.
21.	Stoffel K, Dieter U, Stachowiak G, et al. Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury, 2003, 34 Suppl 2: B11-19.
22.	Miller DL, Goswami T. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing. Clin Biomech (Bristol, Avon), 2007, 22(10): 1049-1062.
23.	MacLeod AR, Pankaj P. Pre-operative planning for fracture fixation using locking plates: device configuration and other considerations. Injury, 2018, 49 Suppl 1: S12-S18.
24.	Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. J Appl Biomech, 2010, 26(1): 10-16.
25.	Kanakaris NK, Obakponovwe O, Krkovic M, et al. Fixation of periprosthetic or osteoporotic distal femoral fractures with locking plates: a pilot randomised controlled trial. Int Orthop, 2019, 43(5): 1193-1204.
26.	Kiyono M, Noda T, Nagano H, et al. Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. J Orthop Surg Res, 2019, 14(1): 384.
27.	Steiner M, Claes L, Ignatius A, et al. Disadvantages of interfragmentary shear on fracture healing—mechanical insights through numerical simulation. J Orthop Res, 2014, 32(7): 865-872.
28.	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: S35-40.
29.	Bottlang M, Doornink J, Fitzpatrick DC, et al. Far cortical locking can reduce stiff ness of locked plating constructs while retaining construct strength. J Bone Joint Surg (Am), 2009, 91(8): 1985-1994.
30.	Epari DR, Duda GN, Thompson MS. Mechanobiology of bone healing and regeneration: in vivo models. Proc Inst Mech Eng H, 2010, 224(12): 1543-1553.
31.	Claes LE, Wilke HJ, Augat P, et al. Effect of dynamization on gap healing of diaphyseal fractures under external fixation. Clin Biomech (Bristol, Avon), 1995, 10(5): 227-234.
32.	Märdian S, Schaser KD, Duda GN, et al. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon), 2015, 30(4): 391-396.
33.	Heyland M, Duda GN, Haas NP, et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury, 2015, 46 Suppl 4: S24-32.
34.	Riedel MD, Oppizzi G, O’Hara NN, et al. Biomechanical comparison of distal femoral fracture fixation: Analysis of non-locked, locked, and far-cortical locked constructs. J Orthop Res, 2020, 38(12): 2573-2579.
35.	Wang R, Zhang H, Cui H, et al. Clinical effects and risk factors of far cortical locking system in the treatment of lower limb fractures. Injury, 2019, 50(2): 432-437.
36.	崔浩诚, 章浩, 丁晨, 等. 对侧皮质锁定螺钉与锁定螺钉治疗股骨远端骨折疗效比较. 现代生物医学进展, 2018, 18(7): 1287-1292, 1343.
37.	Adams JD, Tanner SL, Jeray KJ. Far cortical locking screws in distal femur fractures. Orthopedics, 2015, 38(3): e153-156.
38.	Hofmann-Fliri L, Epari DR, Schwyn R, et al. Biphasic Plating - In vivo study of a novel fixation concept to enhance mechano-biological fracture healing. Injury, 2020, 51(8): 1751-1758.
39.	刘杰, 张文玺, 蒋正宇, 等. 3 D 打印预处理对 A2-3/C2-3 型股骨远端骨折患者的疗效及安全性. 安徽医学, 2020, 41(7): 760-763.
40.	林海滨, 黄文华, 陈宣煌, 等. 基于 3D 打印和接骨板标准件库数字化的股骨远端骨折内固定. 中华医学杂志, 2016, 96(5): 344-348.
41.	蔡泽秦. 混合现实技术在骨科手术中的初步探索与应用. 汕头: 汕头大学, 2018.
42.	谢毅, 张加尧, 叶哲伟. 混合现实技术在创伤骨科的应用与展望. 中华创伤骨科杂志, 2020, 22(11): 1009-1012.

1. 鞠林林, 陈伟, 张奇, 等. 2010 年至 2011 年中国东部与西部地区成人股骨远端骨折的流行病学对比分析. 中华创伤骨科杂志, 2017, 19(5): 417-422.
2. 程家祥, 陈伟, 孙然, 等. 2003 年至 2012 年河北医科大学第三医院成人股骨远端骨折的流行病学分析. 中华创伤骨科杂志, 2014, 16(8): 695-699.
3. Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop, 2018, 42(1): 191-196.
4. Wolf O, Mukka S, Ekelund J, et al. How deadly is a fracture distal to the hip in the elderly? An observational cohort study of 11, 799 femoral fractures in the Swedish Fracture Register. Acta Orthop, 2021, 92(1): 40-46.
5. 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: S8-14.
6. Hake ME, Davis ME, Perdue AM, et al. Modern implant options for the treatment of distal femur fractures. J Am Acad Orthop Surg, 2019, 27(19): e867-e875.
7. DeKeyser GJ, Kellam PJ, Haller JM. Locked plating and advanced augmentation techniques in osteoporotic fractures. Orthop Clin North Am, 2019, 50(2): 159-169.
8. Epari DR, Gurung R, Hofmann-Fliri L, et al. Biphasic plating improves the mechanical performance of locked plating for distal femur fractures. J Biomech, 2021, 115: 110192.
9. Jain D, Arora R, Garg R, et al. Functional outcome of open distal femoral fractures managed with lateral locking plates. Int Orthop, 2020, 44(4): 725-733.
10. 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.
11. Park KH, Oh CW, Park KC, et al. Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg, 2021, 141(2): 207-214.
12. Sanders R, Swiontkowski M, Rosen H, et al. Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg (Am), 1991, 73(3): 341-346.
13. Park KH, Oh CW, Park KC, et al. Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg, 2021, 141(2): 207-214.
14. 庄云强, 张亚弟, 张军, 等. 三种内固定方式治疗股骨远端 Müller 分型 C2 和 C3 型骨折的疗效比较. 中华创伤骨科杂志, 2020, 22(3): 238-242.
15. Elkins J, Marsh JL, Lujan T, et al. Motion predicts clinical callus formation: Construct-specific finite element analysis of supracondylar femoral fractures. J Bone Joint Surg (Am), 2016, 98(4): 276-284.
16. Perren SM. Physical and biological aspects of fracture healing with special reference to internal fixation. Clin Orthop Relat Res, 1979, (138): 175-196.
17. 张俊, 邱永敏, 尹伟忠, 等. 单侧与双侧钢板治疗粉碎性股骨远端骨折的疗效比较. 生物骨科材料与临床研究, 2017, 14(1): 56-60.
18. Bologna MG, Claudio MG, Shields KJ, et al. Dual plate fixation results in improved union rates in comminuted distal femur fractures compared to single plate fixation. J Orthop, 2019, 18: 76-79.
19. Fontenot PB, Diaz M, Stoops K, et al. Supplementation of lateral locked plating for distal femur fractures: A biomechanical study. J Orthop Trauma, 2019, 33(12): 642-648.
20. Lodde MF, Raschke MJ, Stolberg-Stolberg J, et al. Union rates and functional outcome of double plating of the femur: systematic review of the literature. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-03767-6.
21. Stoffel K, Dieter U, Stachowiak G, et al. Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury, 2003, 34 Suppl 2: B11-19.
22. Miller DL, Goswami T. A review of locking compression plate biomechanics and their advantages as internal fixators in fracture healing. Clin Biomech (Bristol, Avon), 2007, 22(10): 1049-1062.
23. MacLeod AR, Pankaj P. Pre-operative planning for fracture fixation using locking plates: device configuration and other considerations. Injury, 2018, 49 Suppl 1: S12-S18.
24. Kanchanomai C, Muanjan P, Phiphobmongkol V. Stiffness and endurance of a locking compression plate fixed on fractured femur. J Appl Biomech, 2010, 26(1): 10-16.
25. Kanakaris NK, Obakponovwe O, Krkovic M, et al. Fixation of periprosthetic or osteoporotic distal femoral fractures with locking plates: a pilot randomised controlled trial. Int Orthop, 2019, 43(5): 1193-1204.
26. Kiyono M, Noda T, Nagano H, et al. Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort. J Orthop Surg Res, 2019, 14(1): 384.
27. Steiner M, Claes L, Ignatius A, et al. Disadvantages of interfragmentary shear on fracture healing—mechanical insights through numerical simulation. J Orthop Res, 2014, 32(7): 865-872.
28. 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: S35-40.
29. Bottlang M, Doornink J, Fitzpatrick DC, et al. Far cortical locking can reduce stiff ness of locked plating constructs while retaining construct strength. J Bone Joint Surg (Am), 2009, 91(8): 1985-1994.
30. Epari DR, Duda GN, Thompson MS. Mechanobiology of bone healing and regeneration: in vivo models. Proc Inst Mech Eng H, 2010, 224(12): 1543-1553.
31. Claes LE, Wilke HJ, Augat P, et al. Effect of dynamization on gap healing of diaphyseal fractures under external fixation. Clin Biomech (Bristol, Avon), 1995, 10(5): 227-234.
32. Märdian S, Schaser KD, Duda GN, et al. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon), 2015, 30(4): 391-396.
33. Heyland M, Duda GN, Haas NP, et al. Semi-rigid screws provide an auxiliary option to plate working length to control interfragmentary movement in locking plate fixation at the distal femur. Injury, 2015, 46 Suppl 4: S24-32.
34. Riedel MD, Oppizzi G, O’Hara NN, et al. Biomechanical comparison of distal femoral fracture fixation: Analysis of non-locked, locked, and far-cortical locked constructs. J Orthop Res, 2020, 38(12): 2573-2579.
35. Wang R, Zhang H, Cui H, et al. Clinical effects and risk factors of far cortical locking system in the treatment of lower limb fractures. Injury, 2019, 50(2): 432-437.
36. 崔浩诚, 章浩, 丁晨, 等. 对侧皮质锁定螺钉与锁定螺钉治疗股骨远端骨折疗效比较. 现代生物医学进展, 2018, 18(7): 1287-1292, 1343.
37. Adams JD, Tanner SL, Jeray KJ. Far cortical locking screws in distal femur fractures. Orthopedics, 2015, 38(3): e153-156.
38. Hofmann-Fliri L, Epari DR, Schwyn R, et al. Biphasic Plating - In vivo study of a novel fixation concept to enhance mechano-biological fracture healing. Injury, 2020, 51(8): 1751-1758.
39. 刘杰, 张文玺, 蒋正宇, 等. 3 D 打印预处理对 A2-3/C2-3 型股骨远端骨折患者的疗效及安全性. 安徽医学, 2020, 41(7): 760-763.
40. 林海滨, 黄文华, 陈宣煌, 等. 基于 3D 打印和接骨板标准件库数字化的股骨远端骨折内固定. 中华医学杂志, 2016, 96(5): 344-348.
41. 蔡泽秦. 混合现实技术在骨科手术中的初步探索与应用. 汕头: 汕头大学, 2018.
42. 谢毅, 张加尧, 叶哲伟. 混合现实技术在创伤骨科的应用与展望. 中华创伤骨科杂志, 2020, 22(11): 1009-1012.

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Current status and progress of locking plate in the treatment of distal femoral comminuted fracture

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