Locked plate fixation for femoral shaft fractures

Fifteen patients with a mean age of 31 years, who had sustained different types of femoral shaft fracture, were treated by locked plate fixation using standard AO dynamic compression plates (DCP). The fracture was open in five patients and ten had other significant injuries. Thirteen patients were available for follow-up at a mean period of 5 months (range, 3-10 months). All fractures united and the mean time to full weight bearing was 8 weeks. Screw failures, with breakage or bending, occurred in five patients and resulted in loss of alignment of the fracture in one. Nine patients regained a full active range of movement of the knee, two had an extension lag of 10 degrees and two had restricted flexion. The strength of the quadriceps muscle was grade 4 to 5 in ten patients and grade 3 in the remaining three. At the end of the study period ten patients had returned to their normal activities, one used a walking stick and two remained under a rehabilitation programme. Our preliminary results suggest that locked plates may offer a useful alternative technique for the treatment of femoral shaft fractures.     

Experiences with plate fixation in 131 femoral shaft fractures

A consecutive series of 131 comminuted fractures of the femur in 123 patients has been reviewed. All fractures were stabilized by means of rigid ASIF-plate fixation (mostly DCP). About 60% of the patients were polyfractured or polytraumatized (including brain, chest and abdominal injuries). In 85% of the cases the fracture was stabilized within 24 h after the accident and usually the patients remained on a ventilator with PEEP for 1 to 2 days postoperatively. Of the 4 postoperative deaths only two patients died of a pulmonary complication. All patients could be reexamined 1-3 years postoperatively. Although a number of them had suffered from complications (osteitis, fatigue fractures of the plate, delayed union) and had to be reoperated,92% of the cases displayed an excellent or good functionl result. The factors to reduce the complication rate(i.e. primary cancellous bonegraft) are being discussed.     

Minimally invasive plate fixation in femoral shaft fractures

Bridge-plating with its advantages in terms of vascularity and bone healing is a well established procedure today in the treatment of comminuted femoral fractures. Bridge-plating means that the fracture site is not interfered with during the operative procedure. This paper introduces a surgical technique in which the plate is inserted through isolated proximal and distal incisions only, behind the vastus lateralis. Alignment is secured by the plates, the fracture site remains untouched, fixation and screw insertion is restricted to the proximal and distal main fragments. Longitudinal femoral fractures extending right into the trochanteric and or condylar areas are the main indication for minimally invasive plate fixations with angled blade plates or condylar screws since fractures which are restricted to the diaphyseal area are mostly treated by nailing today. The surgical trauma resulting from plating by proximal and distal incisions only is less than that associated with conventional techniques. Indirect reduction of femoral fragments is much easier since the integrity of the surrounding muscles and soft tissue is preserved, the fragments often being reduced simply by traction. Adjustment of rotation is an essential aspect requiring careful attention. For special indications, namely comminuted fractures affecting a large part of the femur and extending into the trochanteric or condylar areas, insertion of the plate via proximal and distal incisions only is a further development in bridge-plating which minimizes surgical trauma and operation time.     

Bone atrophy after plate fixation. Computed tomography of femoral shaft fractures

Twelve patients with previous femoral shaft fracture treated by rigid plate fixation were examined by computed tomography (CT) scanning 1 or 2 days after plate removal. In the previously plated segment an average reduction in cortical density of 11 per cent was found, and the reduction was most pronounced in the cortex directly beneath the plate. No reduction in cortical thickness of the plated bone occurred. Proximal and distal to the site of the plate, and in the ipsilateral tibial shaft, a slight reduction in cortical density and thickness averaging 2-3 per cent was found.     

Complications of plate fixation of femoral shaft fractures in children and adolescents

Purpose

This study aims to critically analyze the major and minor complications that may be associated with plate fixation of pediatric diaphyseal femur fractures.

Methods

The medical records of skeletally immature patients (6–15 years of age) who underwent plate fixation of a diaphyseal femur fracture at a tertiary-care level-1 pediatric trauma center between 1/2003 and 12/2010 were reviewed. Demographic and clinical information regarding the mechanism of injury, fracture type, and surgical technique were recorded. Radiographic evaluation of bony healing, hardware position, and deformity was performed throughout the study period. All intraoperative and postoperative complications were recorded. Complication incidence and time from surgery to complication were described. Multivariate logistic regression and multivariate Cox regression models were used to assess the association between different variables and the occurrence of a complication. Kaplan–Meier survivorship curves were used to evaluate the freedom from a complication with longer follow-up.

Results

Over an 8-year period, 85 skeletally immature patients (83 % males, mean age 10.2 years) underwent plate fixation for diaphyseal femur fractures. Overall, complications were identified in 11 patients (13 %). Major complications, defined as those resulting in unplanned reoperation (excluding elective removal of asymptomatic plate/screws), occurred in five patients (6 %) and included two patients (2 %) with wound infections requiring irrigation and debridement, two patients (2 %) with distal femoral valgus deformity (DFVD) leading to osteotomy and hardware removal, respectively, and one patient (1 %) with a 3-cm leg length discrepancy (LLD) requiring epiphysiodesis. Minor complications, defined as those not requiring unplanned operative intervention, occurred in six patients (7 %) and included two patients (2 %) with delayed union, two patients (2 %) with symptomatic screw prominence, one patient (1 %) with a superficial wound infection effectively treated with oral antibiotics, and one patient (1 %) with valgus malunion, which was asymptomatic at early follow-up. There were no intraoperative complications and no reports of postoperative knee stiffness, shortening, or reoperations to address fracture stability. Fifty-two patients (61 %) underwent routine elective removal of hardware without related complications following fracture union. Overall, complications occurred postoperatively at a mean time of 20 months (range 0–65 months), though major complications occurred at a later time point (mean 29.1 months, range 0–65 months) than minor complications (mean 12.5 months, range 0–40.1 months). Longer follow-up was associated with higher occurrence of a complication [p = 0.0012, odds ratio = 1.05, 95 % confidence interval (CI): 1.02–1.08].

Conclusions

The plating of pediatric femur fractures is associated with 6 and 7 % rates of major and minor complications, respectively. There were minimal long-term sequelae associated with the complications noted. This complication rate compares favorably with the published rate of complications (10–62 %) associated with titanium elastic nail fixation of similar fracture types. Most complications occurred >4 months postoperatively, with major complications occurring at a later time point than minor complications. Long-term follow-up of these patients is recommended to ensure that complications do not go undetected.

Level of evidence

Retrospective case series, Level IV.     

Bone atrophy after plate fixation: Computed tomography of femoral shaft fractures

Twelve patients with previous femoral shaft fracture treated by rigid plate fixation were examined by computed tomography (CT) scanning 1 or 2 days after plate removal. In the previously plated segment an average reduction in cortical density of 11 per cent was found, and the reduction was most pronounced in the cortex directly beneath the plate. No reduction in cortical thickness of the plated bone occurred. Proximal and distal to the site of the plate, and in the ipsilateral tibial shaft, a slight reduction in cortical density and thickness averaging 2-3 per cent was found.     

Bone atrophy after plate fixation: Computed tomography of femoral shaft fractures

Twelve patients with previous femoral shaft fracture treated by rigid plate fixation were examined by computed tomography (CT) scanning 1 or 2 days after plate removal. In the previously plated segment an average reduction in cortical density of 11 per cent was found, and the reduction was most pronounced in the cortex directly beneath the plate. No reduction in cortical thickness of the plated bone occurred. Proximal and distal to the site of the plate, and in the ipsilateral tibial shaft, a slight reduction in cortical density and thickness averaging 2–3 per cent was found.     

Femoral shaft fractures treated with plate fixation and interlocked nailing: a comparative retrospective study.

In a retrospective study, the results of 39 patients with fresh unilateral femoral shaft fractures were studied: 19 had been treated with an AO interlocking nail and 20 with an AO plate. The preoperative characteristics of both groups were similar. The interlocking nail procedure took significantly longer (P = 0.002, Wilcoxon's test) and was associated with technical faults in seven patients. Full weight-bearing was allowed significantly earlier (P = 0.001, Wilcoxon's) in the interlocking nail group. Delayed union was observed in three patients in the plate osteosynthesis group but was not encountered in the interlocking nail group. Cancellous autogenous bone grafting was performed seven times during or after plating, but was not necessary in the interlocking nail group. Two cases of osteitis arose after plating and none after interlocked nailing. At follow-up, one patient in each group was suffering from serious complaints. Conclusion: The interlocking nail procedure took longer than plating, but allowed earlier full weight-bearing. The final results were similar in both groups of patients.     

External callus formation of closed femoral shaft fractures treated by medullary fixation

Various radiographic patterns were observed for external callus formation of closed femoral shaft fractures treated by closed and open medullary Rush pin fixation. Closed pinning tends to form more adequate lateral callus, to have less looping of bridging callus over the cortex, and to form smooth, dense callus. Open pinning tends to form less lateral callus, to have more looping (radiolucent space under callus) of the callus over the cortex and fracture site, and to have areas of exuberant callus with the appearance of myositis ossificans. The circulatory status of the cortex and soft tissues seem to be a factor in these callus patterns. Avascular cortex of shaft fractures is inferred by the radiographic findings of bridging callus loops over the cortex, relative increased density of cortical bone, and resorption of cortical bone.     

Dynamic hip screw and compression plate fixation of ipsilateral femoral neck and shaft fractures

PURPOSE: To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures. METHODS: Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification. RESULTS: The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6-degree varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Functional results were good in 29 patients, fair in 5, and poor in 3. CONCLUSION: The use of dynamic hip screws and compression plates for ipsilateral femoral neck and shaft fractures is reliable in achieving bone union with few complications.     

Interprosthetic femoral fractures treated with locking plate

Purpose

Interprosthetic fractures are challenging to manage. Although treatment of femoral fractures around a single implant has been described, there is little literature for treatment of interprosthetic femoral fractures. This study analyses the management and outcomes of 15 patients with interprosthetic femoral fractures treated with locking plates.

Methods

A retrospective chart review was conducted of 17 patients with interprosthetic femur fracture treated with locking plates from 2002 to 2013. Patient demographics and comorbidities were collected. Preoperatively, patients were classified with the Vancouver or Su classification system. Intraoperative use of bone graft and/or cerclage cables was also examined. Clinical and radiographic outcomes were evaluated for union, time to full weight bearing, return to preinjury level of activity, and pain assessed with visual analog scale (VAS).

Results

There were 15 patients with interprosthetic fractures meeting criteria for this study. Average patient age was 80.53 (range, 61–92) years. Bone grafting was used in 23.5 % (four of 17) and cerclage cables in 29.4 % (five of 17). Patients achieved complete union and return to full weight bearing an average of 4.02 (range, two to six) months later. Average VAS pain score was 1.00 (range, zero to six). All patients returned to their preoperative ambulatory status.

Conclusion

Locking plates could achieve satisfactory results for interprosthetic fractures. Considering an individual’s fracture type, bone quality and protheses to determine the appropriate plate length and optional use of cerclage and/or bone graft was essential. In this limited sample size, interprosthetic fractures occurred at similar rates at the supracondylar region and diaphysis.     

加压钢板治疗股骨干骨折30例失败原因分析

自1990年1996年,我们共收治股骨干骨折加压钢板螺钉固定失败30例,我们认为失败原因:1、操作技术失误;2、过早负重及意外摔伤;3、对粉碎折或骨缺损者未进行一期植骨。作者强调正确操作解剖复位,坚强内固定,一期植骨及正确功能锻炼是预防加压钢板失败的重要措施。     

External fixation of complex femoral shaft fractures

Conversion of temporary external fixation to an intramedullary nail within the first 2 weeks after a femoral shaft fracture is standard practice. However, due to financial constraints, in large parts of the world external fixation of femoral shaft fractures is often the definitive treatment. Out of 60 fractures, 47 were followed-up for a minimum period of 39 weeks. The average follow-up time was 75 weeks. Fourteen fractures were closed, and 33 open. Forty-four fractures united at an average of 31 weeks. There were four non-unions, three of them infected. Secondary surgical procedures were performed for four non-unions and in eight cases of delayed union. One re-fracture occurred, which was successfully treated with repeat external fixation. Only six patients regained full range of motion. The average flexion was 72 degrees . Pin tract infections occurred in 26 patients, leading to loosening of four pins. Satisfactory results can be obtained with definitive external fixation of femoral shaft fractures. Pin tract infections, although a common occurrence, are not a major problem and can be treated by local wound care and antibiotic therapy. The most common problem is significant decrease in the range of motion of the knee.     

Experience with plate osteosynthesis in femoral shaft fractures]

Today, femoral shaft fractures are often treated by open or closed intramedullary nailing because of a lower rate of complications with this method. Therefore, the practice of plating these fractures is now decreasing. We studied the indications for nailing and for plating, as well as the indications when both methods can be used with the same results. At the University Clinic of Surgery in Graz, 107 femoral shaft fractures were plated between 1983-1986. We could find no higher incidence of complications between plating or nailing femoral fractures described by previous authors compared with our own results.     

Comparison of compression plate and flexible intramedullary nail fixation in pediatric femoral shaft fractures

The purpose of this study was to compare the results of compression plating and flexible intramedullary nailing for pediatric femoral shaft fractures. Thirty-eight consecutive patients with 40 femoral shaft fractures were evaluated. Twenty-two femoral segments were treated with a compression plate and 18 femoral segments were treated with flexible intramedullary nailing. The time to healing, operation time and complications were evaluated. The average operation time was statistically significantly shorter in the nailing group (P=0.039). Four implant failures occurred in the compression plate group whereas one non-union was observed in the flexible nailing group. Flexible intramedullary nailing seems to provide a high union rate with a shorter operation time when compared with plate fixation.     

解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折

 目的 评价采用解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折的临床疗效。方法 2009 年1 月至2011年6 月, 采用解剖型锁定钢板固定治疗累及股骨干的转子间或转子下骨折者72 例, 64 例患者获得随访。男50 例, 女14例;年龄21~79 岁, 平均42.8岁。所有患者均为股骨单侧闭合性骨折。受伤至手术时间间隔为2 h~16 d, 平均4.6 d。术后第l、3、6、9、12 个月门诊随访, 以后每年至少门诊复查一次。随访时所有患者均拍摄股骨正、侧位X 线片。临床疗效评价采用Harris髋关节功能评分标准。结果 64 例患者手术时间45~120 min, 平均65 min;术中出血量50~650 ml, 平均210 ml。所有患者均于术后3~15 d可下地扶拐行走。随访期间所有患者均未出现感染、下肢静脉血栓、螺钉切割股骨头及断钉现象, 2 例患者出现髋内翻短缩畸形, 无骨折不愈合患者。骨折愈合时间为3.6~10.5 个月, 平均5.2 个月。按Harris髋关节功能评分标准: 优45 例, 良14 例, 可5 例, 优良率为92.19豫(59/64)。结论 解剖型锁定钢板固定治疗方法具有微创、固定强度高、生物力学特性佳等特点, 在治疗累及股骨干的转子间或转子下骨折时具骨愈合率高、功能恢复快、并发症少等优点。     

锁定钢板治疗锁骨粉碎性骨折

<正>2010年9月~2012年12月,我科采用锁定加压钢板治疗66例粉碎性骨折患者,疗效满意,报道如下。1材料与方法1.1病例资料本组66例,男55例,女11例,年龄22~67岁。骨折类型:锁骨中段37例,中外1/3处29例。66例均系粉碎性闭合性。患者均未合并血管神经损伤。1.2治疗方法臂丛麻醉。以锁骨骨折为中心,沿锁骨上缘做6~8 cm的横切口,骨折断端略作剥离,尽量保留碎骨     

Double locking plate fixation for femoral shaft nonunion

Introduction

Nonunions after operative fixation of the femur, although infrequent, remain a challenge for orthopedic surgeons. The aim of this study was to assess the effectiveness of double locking plate fixation in the treatment for femoral shaft nonunions.

Materials and methods

From 2009 to 2013, 21 patients with femoral nonunions (mean age 46.9 years, range 25–81) were treated and evaluated utilizing double locking plate fixation. Patients were followed for at least 6 months postoperatively or until they achieved complete union to investigate bone healing and functional outcomes in femoral shaft nonunions treated with double locking plate and autogenous cancellous bone graft.

Results

The main outcomes evaluated were the presence of bony union, time to achieve union, and SF-36 score. All 21 femoral nonunions healed (100 % union rate). The average time to bony union was 5.3 months (range, 4–7). The mean follow-up duration time was 24.8 months (range, 6–60). Average scores of the physical function and bodily pain components of the SF-36 were 96 (range, 90–99) and 94.2 (range, 92–99), respectively. No significant complications were noted postoperatively.

Conclusion

Because of the high union rates and lack of significant complications in our series, double locking plate fixation can serve as an effective method of addressing femoral shaft nonunions. No significant complications were found postoperatively.

     

Ipsilateral hip and femoral shaft fractures treated with intramedullary nails

This study retrospectively analysed 34 patients with ipsilateral hip and femoral shaft fractures treated over a period of 10 years between January 1995 and January 2005. They had an average age of 35 years. Twenty-six (76.47%) of these cases suffered high-velocity trauma (RTA); six others had fallen from a height (17.65%), and two had suffered only minimal trauma (5.88%). Twenty were extracapsular (58.82%) and 14 were intracapsular. They were evaluated with an average follow-up of 28 months, both clinically and radiologically; 26 patients (76.47%) had a good result (Friedman and Wyman score). When the intracapsular fracture was detected postperatively, there was one delayed union and one non-union. When the fracture is diagnosed preoperatively, we recommend reconstruction nail fixation. If the hip fracture is diagnosed intra- or postoperatively following nailing of the shaft, we propose the miss-a-nail technique as an option.

---

Résumé Etude rétrospective de 34 patients, d’age moyen 35 ans, qui présentaient une fracture homolatérale du col et de la diaphyse fémorale entre janvier 1995 et janvier 2005. 26 cas (76,47%) étaient survenus après un traumatisme à haute énergie, 6 (17,65%) après une chute d’une hauteur importante et 2 (5,88%) après un traumatisme minime. 20 fractures du col étaient extracapsulaires et 14 intracapsulaires. L’évaluation clinique et radiologique était faite avec un recul moyen de 28 mois et montrait 76,47% de bons résultats selon le score de Friedman et Wyman. Quand la fracture intracapsulaire était détectée après l’opération il y avait un retard de consolidation et une pseudarthrose. Quand la fracture du col est diagnostiquée précocement nous recommandons la fixation par clou. Si cette fracture est diagnostiquée pendant ou après l’enclouage diaphysaire, nous proposons une technique de clou perdu comme option thérapeutique.