Locked plating for internal fixation of the adult distal femur: Influence of the type of construct and hardware on the clinical and radiological outcomes - 05/09/14

Doi : 10.1016/j.otsr.2014.06.005

M. Ehlinger ^a,^⁎ , F. Dujardin ^b, L. Pidhorz ^c, P. Bonnevialle ^d, G. Pietu ^e, E. Vandenbussche ^f
and the
SoFCOT^g
^a Service de chirurgie orthopédique et de traumatologie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
^b Service de chirurgie orthopédique et traumatologique, 1, rue de Germont, 76000 Rouen, France
^c Service de chirurgie orthopédique et traumatologique, 194, avenue Rubillard, 72037 Le Mans, France
^d Institut de l’appareil locomoteur, département d’orthopédie traumatologie, hôpital Riquet, place Baylac, 31052 Toulouse cedex, France
^e Service de chirurgie orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
^f Service de chirurgie orthopédique et traumatologique, université René-Descartes, hôpital Européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris cedex, France
^g Société française de chirurgie orthopédie et de traumatologie (SoFCOT), 56, rue Boissonade, 75014 Paris cedex, France

^⁎Corresponding author.

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Abstract

Introduction

Distal femoral fractures are rare and serious. Along with traditional internal fixation, new, dedicated hardware have appeared (distal nails, locked plating). We report the results of a multicenter prospective study of these fractures treated with locked plating.

Hypothesis

The short-term results are satisfactory and related to the type of construct and the hardware used, with better results for elastic assemblies and titanium implants.

Materials and methods

From June 2011 to May 2012, 92 patients, mean age 64 years, were included in 12 centres. The fractures were classified as follows: 44 type A, 7 type B, and 41 type C according to the AO classification. Thirteen fractures were open. The plates were uniaxial. The assemblies were elastic in 52 cases, rigid in 26, and unconventional in 14.

Results

Seventy-six patients underwent a radiological follow-up at 6months and 66 patients had a clinical result evaluated at 1year. The mean range of motion was 100° and the mean IKS score was 122. The bone union rate was 87% within 12weeks. Seven valgus, two varus, ten flexion deformities, and three recurvatum greater than 5° were observed (19.5%). Revisions involved two cases with loss of fixation, five cases of infection, and one case of arthrofibrosis (requiring arthroscopic arthrolysis). Secondary bone grafting was carried out in seven cases (four successfully). No influence of the type of assembly or the hardware used was demonstrated.

Discussion

The results remain modest, underscoring the severity of these fractures. Neither the type of construct nor the hardware used influenced the radiological and clinical outcomes. The hypothesis was not confirmed.