nach oben

European Journal of Orthopaedic Surgery & Traumatology

Erschienen in:

14.07.2017 | Original Article • LOWER LIMB - FRACTURES

Double plating of intra-articular multifragmentary C3-type distal femoral fractures through the anterior approach

verfasst von: Mohamed A. Imam, Ahmed Torieh, Ahmed Matthana

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 1/2018

Einloggen, um Zugang zu erhalten

Abstract

Introduction

In this prospective case series, we report a mean of 12-month follow-up of the utilization of a dual plating of distal femoral fractures. Our technique included a lateral distal femoral locked plate with a low-contact-locked medial plate and bone graft through an extended medial parapatellar anterior approach for the fixation of C3-type distal femoral fractures.

Patients and methods

Sixteen patients (11 males and 5 females) presented with supracondylar femoral fracture type C3, according to Müller long-bone classification system and its revision OA/OTA classification. These were treated using dual plating through extended anterior approach and bone grafting. Our outcomes included clinical and radiological outcomes. Secondary outcomes included postoperative complications.

Results

The mean time of complete radiological union in the studied population was 6.0 ± 3.5 months with a range of 3–14 months. We have not observed postoperative varus or valgus deformity in our cohort. The majority (68.75%) of the studied patients showed significant improvement in range of motion (90°–120°) during follow-up. Eleven out of sixteen patients (68.75%) had well-to-excellent functional outcome. Poor outcome was reported in only two patients (12.50%).

Conclusions

Dual plating fixation using anterior approach for type C3 distal femoral fractures is an efficient method of management. It has several advantages such as precise exposure, easy manipulation, anatomical reduction and stable fixation. However, operative indications and instructions should be strictly followed. The surgical technique must be rigorous, and the biomechanical qualities of these implants must be understood to prevent the development of major complications.

Gangavalli AK, Nwachuku CO (2016) Management of distal femur fractures in adults: an overview of options. Orthop Clin N Am 47:85–96CrossRef

Crist BD, Della Rocca GJ, Murtha YM (2008) Treatment of acute distal femur fractures. Orthopedics 31:681–690CrossRefPubMed

Zlowodzki M, Bhandari M, Marek DJ, Cole PA, Kregor PJ (2006) Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989–2005). J Orthop Trauma 20:366–371CrossRefPubMed

Wang A, Zong S, Su L, Liang W, Cao X, Zheng Q, Li L, Zhao X, Kan S (2016) Meta-analysis of postoperative complications in distal femoral fractures: retrograde intramedullary nailing versus plating. Int J Clin Exp Med 10:18900–18911

Khalil Ael S, Ayoub MA (2012) Highly unstable complex C3-type distal femur fracture: can double plating via a modified Olerud extensile approach be a standby solution? J Orthop Traumatol 13:179–188CrossRef

Asim M, El-Menyar A, Al-Thani H, Abdelrahman H, Zarour A, Latifi R (2014) Blunt traumatic injury in the Arab Middle Eastern populations. J Emerg Trauma Shock 7:88–96CrossRefPubMedPubMedCentral

Fingerhut LA, Harrison J, Holder Y, Frimodt-Moller B, Mackenzie S, Mulder S, Scott I (2005) Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health 95:1089–1090CrossRefPubMedPubMedCentral

Hofman K, Primack A, Keusch G, Hrynkow S (2005) Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health 95:13–17CrossRefPubMedPubMedCentral

Bener A, Abdul R, Yassir S, Abdel Aleem EY, Khalid MK (2012) Trends and characteristics of injuries in the State of Qatar: hospital-based study. Int J Inj Control Saf Promot 19:368–372CrossRef

10.

Al-Kharusi W (2008) Update on road traffic crashes: progress in the Middle East. Clin Ortho Relat Res 466:2457–2464CrossRef

11.

Imam MA, Fathalla I, Holton J, Nabil M, Kashif F (2016) Cementless total hip replacement for the management of severe developmental dysplasia of the hip in the middle eastern population: a prospective analysis. Front Surg 3:31CrossRefPubMedPubMedCentral

12.

Nork SE, Segina DN, Aflatoon K, Barei DP, Henley MB, Holt S, Benirschke SK (2005) The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. J Bone Jt Surg Am Vol 87:564–569CrossRef

13.

Sanders R, Swiontkowski M, Rosen H, Helfet D (1991) Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Jt Surg Am Vol 73:341–346CrossRef

14.

Agrawal A, Kiyawat V (2017) Complex AO type C3 distal femur fractures: results after fixation with a lateral locked plate using modified swashbuckler approach. Indian J Orthop 51:18–27CrossRefPubMedPubMedCentral

15.

Koval KJ, Kummer FJ, Bharam S, Chen D, Halder S (1996) Distal femoral fixation: a laboratory comparison of the 95 degrees plate, antegrade and retrograde inserted reamed intramedullary nails. J Orthop Trauma 10:378–382CrossRefPubMed

16.

Kohli S, Chauhan S, Vishwakarma N, Salgotra K (2016) Functional and radiological outcomes of distal femur intra articular fractures treated with locking compression plate. Int J Orthop Sci 2:17–21CrossRef

17.

Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q (2010) Distal femoral fractures: current concepts. J Am Acad Orthop Surg 18:597–607CrossRefPubMed

18.

Struhl S, Szporn MN, Cobelli NJ, Sadler AH (1990) Cemented internal fixation for supracondylar femur fractures in osteoporotic patients. J Orthop Trauma 4(2):151–157CrossRefPubMed

19.

Benum P (1977) The use of bone cement as an adjunct to internal fixation of supracondylar fractures of osteoporotic femurs. Acta Orthop Scand 48:52–56CrossRefPubMed

20.

Bolhofner BR, Carmen B, Clifford P (1996) The results of open reduction and Internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma 10:372–377CrossRefPubMed

21.

Chen YT, Yang JW, Hou HB, Wang CS, Wang KZ (2015) Comparative study of less invasive stabilization system (LISS) and the condylar support plates for the treatment of AO type C distal femoral fractures in adults. Zhongguo Gu Shang 28:136–140PubMed

22.

Fankhauser F, Gruber G, Schippinger G, Boldin C, Hofer HP, Grechenig W, Szyszkowitz R (2004) Minimal-invasive treatment of distal femoral fractures with the LISS (less invasive stabilization system): a prospective study of 30 fractures with a follow up of 20 months. Acta Orthop Scand 75:56–60CrossRefPubMed

23.

Henry SL (2000) Supracondylar femur fractures treated percutaneously. Clin Orthop Relat Res 375:51–59CrossRef

24.

Schutz M, Muller M, Kaab M, Haas N (2003) Less invasive stabilization system (LISS) in the treatment of distal femoral fractures. Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca 70:74–82PubMed

25.

Schutz M, Muller M, Regazzoni P, Hontzsch D, Krettek C, Van der Werken C, Haas N (2005) Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orth Trauma Surg 125:102–108CrossRef

26.

Tornetta P 3rd, Tiburzi D (1994) Anterograde interlocked nailing of distal femoral fractures after gunshot wounds. J Orthop Trauma 8:220–227CrossRefPubMed

27.

Meyer RW, Plaxton NA, Postak PD, Gilmore A, Froimson MI, Greenwald AS (2000) Mechanical comparison of a distal femoral side plate and a retrograde intramedullary nail. J Orthop Trauma 14:398–404CrossRefPubMed

28.

Della Torre P, Aglietti P, Altissimi M (1980) Results of rigid fixation in 54 supracondylar fractures of the femur. Arch Orthop Trauma Surg 97:177–183CrossRefPubMed

29.

Mize RD (1989) Surgical management of complex fractures of the distal femur. Clin Orthop Relat Res 240:77–86

30.

Arazi M, Memik R, Ogun TC, Yel M (2001) Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Jt Surg Br Vol 83:663–667CrossRef

31.

Schandelmaier P (2002) Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Jt Surg Br Vol 84:148–149CrossRef

32.

Ziran BH, Rohde RH, Wharton AR (2002) Lateral and anterior plating of intra-articular distal femoral fractures treated via an anterior approach. Int Orthop 26:370–373CrossRefPubMedPubMedCentral

33.

Zhang ZM, Jiu L, Huang CX, Zhao ZF, Wang G, Qin CC (2012) Treatment of type C3 distal femoral fractures with double-plating fixation via anterior middle approach. Zhongguo Gu Shang 25:1049–1052PubMed

34.

Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M (2010) Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma 24:156–162CrossRefPubMed

35.

Imam MA, Barke S, Stafford GH, Parkin D, Field RE (2014) Loss to follow-up after total hip replacement: a source of bias in patient reported outcome measures and registry datasets? Hip Int J Clin Exp Res Hip Pathol Ther 24:465–472

Titel: Double plating of intra-articular multifragmentary C3-type distal femoral fractures through the anterior approach
verfasst von: Mohamed A. Imam
Ahmed Torieh
Ahmed Matthana
Publikationsdatum: 14.07.2017
Verlag: Springer Paris
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 1/2018
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI: https://doi.org/10.1007/s00590-017-2014-9

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Sind Frauen die fähigeren Ärzte?

30.04.2024 Gendermedizin Nachrichten

Patienten, die von Ärztinnen behandelt werden, dürfen offenbar auf bessere Therapieergebnisse hoffen als Patienten von Ärzten. Besonders gilt das offenbar für weibliche Kranke, wie eine Studie zeigt.

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Introduction

Patients and methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 1/2018

Biographical background and origin of common eponymous terms in orthopedic surgery: anatomy and fractures in knee surgery

Clinical and radiological results 7 years after Copeland shoulder resurfacing arthroplasty in patients with primary glenohumeral osteoarthritis: an independent multicentre retrospective study

Cementless, modular, distally fixed stem in hip revision arthroplasty: a single-center study of 132 consecutive hips

Optimization of technique for insertion of implants at the supra-acetabular corridor in pelvis and acetabular surgery

The mechanical effects of cup inclination and anteversion angle on the bearing surface