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Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis

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Abstract

Introduction

Although lateral locking plate has shown promising results in distal femur fracture, there are high rates of varus collapse and implant failure in comminuted metaphyseal and articular fractures. This systematic review evaluates the functional outcomes and complications of dual plating in the distal femur fracture.

Materials and methods

Manual and electronic search of databases (PubMed, Medline Embase and Cochrane Central Register of Controlled Trials) was performed to retrieve studies on dual plate fixation in the distal femur fracture. Of the retrieved 925 articles, 12 were included after screening.

Results

There were one randomized-controlled, four prospective and seven retrospective studies. A total of 287 patients with 292 knees were evaluated (dual plating 213, single plating 76, lost to follow-up 3). The nonunion and delayed union rates following dual plate fixations were up to 12.5% and 33.3%, respectively. The mean healing time ranged from 11 weeks to 18 months. Good to excellent outcome was observed in 55–75% patients. There was no difference between the single plate and dual plate fixation with regards to the functional outcomes (VAS score, Neer Score and Kolmert's standard) and complications. Pooled analysis of the studies revealed a longer surgical duration (MD − 16.84, 95% CI − 25.34, − 8.35, p = 0.0001) and faster healing (MD 5.43, 95% CI 2.60, 8.26, p = 0.0002) in the double plate fixation group, but there was no difference in nonunion rate (9.2% vs. 0%, OR 4.95, p = 0.13) and blood loss (MD − 9.86, 95% CI − 44.97, 25.26, p = 0.58).

Conclusion

Dual plating leads to a satisfactory union in the comminuted metaphyseal and articular fractures of the distal femur. There is no difference between the single plate and dual plate with regards to nonunion rate, blood loss, functional outcomes and complications. However, dual fixation leads to faster fracture healing at the cost of a longer surgical duration.

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Authors and Affiliations

  1. Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019, India

    Sujit Kumar Tripathy, Narayan Prasad Mishra, Paulson Varghese & Sibasish Panigrahi

  2. Department of Orthopedics, Boston VA Medical Centre, 150 S Huntington Avenue, Boston, MA, 02130, USA

    Prabhudev Prasad Purudappa

  3. Joan C Edwards School of Medicine, Marshall University, Huntington, WV, USA

    Akshay Goel

  4. Department of Orthopaedics, Max Hospital, Mohali, India

    Ramesh Kumar Sen

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Tripathy, S.K., Mishra, N.P., Varghese, P. et al. Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis. JOIO 56, 183–207 (2022). https://doi.org/10.1007/s43465-021-00489-0

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