- Title
- Supplementary medial plating in revision surgery for distal femoral fractures: A surgical technique with clinical outcomes
- Creator
- Lee, Hoi S.; Lewis, Daniel P.; Balogh, Zsolt J.
- Relation
- Injury Vol. 55, Issue 2, no. 111272
- Publisher Link
- http://dx.doi.org/10.1016/j.injury.2023.111272
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2024
- Description
- Introduction: Distal femur fractures (DFF) are common, especially in the elderly and high energy trauma patients. Lateral locked osteosynthesis constructs have been widely used, however non-union and implant failures are not uncommon. Recent literature advocates for the liberal use of supplemental medial plating to augment lateral locked constructs. However, there is a lack of proprietary medial plate options, with some authors supporting the use of repurposing expensive anatomic pre-contoured plates. The aim of this study was to investigate the feasibility of an effective, readily available medial implant option. Methods: A retrospective analysis from January 2014 to August 2023 was performed on DFF requiring revision open reduction internal fixation (rORIF) with supplemental medial plating with a Large Fragment Locking Compression Plate (LCP) T-Plate via a medial sub-vastus approach. The T-plate was contoured and placed superior to the medial condyle. A combination of 4.5 mm cortical, 5 mm locking and/or 6.5 mm cancellous screws were used, with oblique screw trajectories towards the distal lateral cortex of the lateral condyle. The primary outcome was union rate. Results: This technique was utilised on fifteen patients. The mean age was 55±15 (range 23–81); 73 % of cases were male and the median follow-up was 61 weeks (IQR 49–87). The two most common fracture patterns were AO/OTA 33-C3 (n = 5) and 33-A3 (n = 4), and three patients had open fractures. The union rate was 93 % (14/15), with a median time to union of 29 weeks (IQR 18–49). There were two complications: a deep infection requiring two debridements and locally eluding antibiotic insertion, and a prominent screw requiring removal; both patients achieved union. The median range of motion was 0° (IQR 0–5) of extension and 100° (IQR 90–120) of flexion. Conclusion: Supplemental medial plating of DFF with a Large Fragment LCP T-Plate is a feasible, safe, and economical option for rORIF. Further validation on a larger scale is warranted, along with considerations to developing a specific implant in line with these principles.
- Subject
- dual plating; distal femur fracture; medial plating; non-union
- Identifier
- http://hdl.handle.net/1959.13/1498272
- Identifier
- uon:54506
- Identifier
- ISSN:0020-1383
- Rights
- x
- Language
- eng
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