Dual Plating of the Distal Femur: Indications and Surgical Techniques

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2020 Jan 7

PMID 31903313

Citations 16

Authors

Arnab Sain

Vijay Sharma

Kamran Farooque

Muthukumaran V

Kirubakaran Pattabiraman

Affiliations

Soon will be listed here.

Abstract

Dual-plating of the distal femur is required in some cases to achieve stable fixation. The indications of a medial plate in addition to the lateral plate are medial supracondylar bone loss, low trans-condylar bicondylar fractures, medial Hoffa fracture, peri-prosthetic distal femur fractures, non-union after failed fixation with single lateral plate, poor bone quality and comminuted distal femur fractures (AO type C3). We recommend orthogonal plate configuration with locked plates by a single incision or dual incision approach as per surgeon choice.

Citing Articles

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Integrated Nail and Plate Fixation with Allograft in the Management of Osteoporotic Intra-articular Distal Femur Fracture - A Case Report.

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Comparative study of retrograde intramedullary nailing versus locking extramedullary plating in complete articular fractures with metaphyseal comminution of the distal femur.

Yoon Y, Kim Y, Pesante B, Chun Y, Lee S, Sohn H Arch Orthop Trauma Surg. 2024; 144(5):2109-2118.

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Distal femur fractures management and evolution in the last century.

Nester M, Borrelli Jr J Int Orthop. 2023; 47(8):2125-2135.

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Novel classification system for periprosthetic distal femoral fractures: a consideration for comminution.

Laubach L, Sharma V, Krumme J, Larkin K, Satpathy J Eur J Orthop Surg Traumatol. 2023; 33(6):2541-2546.

PMID: 36635567 DOI: 10.1007/s00590-022-03468-9.

References

Meneghini R, Keyes B, Reddy K, Maar D . Modern retrograde intramedullary nails versus periarticular locked plates for supracondylar femur fractures after total knee arthroplasty. J Arthroplasty. 2014; 29(7):1478-81. DOI: 10.1016/j.arth.2014.01.025. View

Vallier H, Immler W . Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma. 2011; 26(6):327-32. DOI: 10.1097/BOT.0b013e318234d460. View

Streubel P, Ricci W, Wong A, Gardner M . Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res. 2010; 469(4):1188-96. PMC: 3048257. DOI: 10.1007/s11999-010-1530-2. View

Steinberg E, Elis J, Steinberg Y, Salai M, Ben-Tov T . A double-plating approach to distal femur fracture: A clinical study. Injury. 2017; 48(10):2260-2265. DOI: 10.1016/j.injury.2017.07.025. View

Salas C, Mercer D, DeCoster T, Reda Taha M . Experimental and probabilistic analysis of distal femoral periprosthetic fracture: a comparison of locking plate and intramedullary nail fixation. Part A: experimental investigation. Comput Methods Biomech Biomed Engin. 2011; 14(2):157-64. DOI: 10.1080/10255842.2010.535816. View

Davison B . Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop (Belle Mead NJ). 2003; 32(1):27-30. View

Rajasekaran R, Jayaramaraju D, Palanisami D, Agraharam D, Perumal R, Kamal A . A surgical algorithm for the management of recalcitrant distal femur nonunions based on distal femoral bone stock, fracture alignment, medial void, and stability of fixation. Arch Orthop Trauma Surg. 2019; 139(8):1057-1068. DOI: 10.1007/s00402-019-03172-0. View

Ebraheim N, Buchanan G, Liu X, Cooper M, Peters N, Hessey J . Treatment of Distal Femur Nonunion Following Initial Fixation with a Lateral Locking Plate. Orthop Surg. 2016; 8(3):323-30. PMC: 6584123. DOI: 10.1111/os.12257. View

Salas C, Mercer D, DeCoster T, Reda Taha M . Experimental and probabilistic analysis of distal femoral periprosthetic fracture: a comparison of locking plate and intramedullary nail fixation. Part B: probabilistic investigation. Comput Methods Biomech Biomed Engin. 2011; 14(2):175-82. DOI: 10.1080/10255842.2010.539207. View

10.

El Beaino M, Morris R, Lindsey R, Gugala Z . Biomechanical Evaluation of Dual Plate Configurations for Femoral Shaft Fracture Fixation. Biomed Res Int. 2019; 2019:5958631. PMC: 6512036. DOI: 10.1155/2019/5958631. View

11.

Assari S, Kaufmann A, Darvish K, Park J, Haw J, Safadi F . Biomechanical comparison of locked plating and spiral blade retrograde nailing of supracondylar femur fractures. Injury. 2013; 44(10):1340-5. DOI: 10.1016/j.injury.2013.04.016. View

12.

Gwathmey Jr F, Jones-Quaidoo S, Kahler D, Hurwitz S, Cui Q . Distal femoral fractures: current concepts. J Am Acad Orthop Surg. 2010; 18(10):597-607. DOI: 10.5435/00124635-201010000-00003. View

13.

Metwaly R, Zakaria Z . Single-Incision Double-Plating Approach in the Management of Isolated, Closed Osteoporotic Distal Femoral Fractures. Geriatr Orthop Surg Rehabil. 2018; 9:2151459318799856. PMC: 6236632. DOI: 10.1177/2151459318799856. View

14.

Frigg R, Appenzeller A, Christensen R, Frenk A, Gilbert S, Schavan R . The development of the distal femur Less Invasive Stabilization System (LISS). Injury. 2002; 32 Suppl 3:SC24-31. DOI: 10.1016/s0020-1383(01)00181-4. View

15.

Christodoulou A, Terzidis I, Ploumis A, Metsovitis S, Koukoulidis A, Toptsis C . Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods. Arch Orthop Trauma Surg. 2004; 125(2):73-9. DOI: 10.1007/s00402-004-0771-5. View

16.

Kregor P, Stannard J, Zlowodzki M, Cole P, Alonso J . Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): the technique and early results. Injury. 2002; 32 Suppl 3:SC32-47. DOI: 10.1016/s0020-1383(01)00182-6. View

17.

Cicek H, Tuhanioglu U, Ogur H, Seyfettinoglu F, Bozkurt M . An alternative treatment for osteoporotic Su Type III periprosthetic supracondylar femur fractures: Double locking plate fixation. Acta Orthop Traumatol Turc. 2018; 52(2):92-96. PMC: 6136332. DOI: 10.1016/j.aott.2017.09.010. View

18.

Imam M, Torieh A, Matthana A . Double plating of intra-articular multifragmentary C3-type distal femoral fractures through the anterior approach. Eur J Orthop Surg Traumatol. 2017; 28(1):121-130. DOI: 10.1007/s00590-017-2014-9. View

19.

Todorov D, Zderic I, Richards R, Lenz M, Knobe M, Enchev D . Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?. J Orthop Res. 2018; 36(10):2604-2611. DOI: 10.1002/jor.24047. View

20.

Karam J, Campbell P, David M, Hunter M . Comparison of outcomes and analysis of risk factors for non-union in locked plating of closed periprosthetic and non-periprosthetic distal femoral fractures in a retrospective cohort study. J Orthop Surg Res. 2019; 14(1):150. PMC: 6534870. DOI: 10.1186/s13018-019-1204-z. View