Clinical effects and risk factors of far cortical locking system in the treatment of lower limb fractures

Introduction

This study aims to analyze clinical effects between far cortical locking (FCL) system and standard plating techniques in the treatment of lower limb fractures and identify potential preoperative risk factors for complications in patients treated with FCL system.

Method

We retrospectively analyzed 76 patients treated with FCL system (the study group) and 68 patients treated with standard plating techniques (the control group) between January 2014 and January 2017. Patients were followed up for a minimum of one year. Surgery-related complications, fixation features, fracture healing rates, the radiographic union scores, and knee functions (Kolment scores) were analyzed between the two groups in the study. Besides, we analyzed eight preoperative characteristics for surgery-related complications, including age, gender, presence of risk factors affecting bone healing, cause of injury, AO/OTA fracture classifications, facture sites, presence of open fractures, and presence of bone losses.

Results

The distributions of baseline date were similar between the two groups (P＞0.05). The average number of FCL screws was 4.5 (range: 3–9) in the study group. The average time to union was 2.8?±?0.9 months in the study group and 3.6?±?1.0 months in the control group (P＜0.001), and average time to whole weight bearing was 2.3?±?0.8 months and 2.8?±?1.2 months, respectively (P?=?0.004). Regarding radiographic union score, the study group scores were significantly higher than the control group scores at 1 and 3 months after surgery (P＜0.001), while it becomes insignificant between the two groups at 6 and 12 months after surgery (P?=?0.19 and P?=?0.15).The working lengths, fracture healing rates, complication rates, and Kolment scores were similar between the two groups (P＞0.05). In the multivariate analysis, fracture sites (OR?=?5.34; 95% CI, 1.11–25.75; P?=?0.03) and presence of open fractures (OR?=?6.19; 95% CI, 1.05–36.38; P?=?0.04) were significant associated with complications, whereas other variables were not included.

Discussion

FCL system can truly accelerating bone healing and allow earlier whole weight bearing. Fracture healing rates and complication rates were similar between patients treated with FCL implants or conventional plating techniques. Patients with shaft fractures and open fractures trended to have higher complication rates.

Conclusions

FCL system is superior to standard plating technique in terms of early callus formation, but standard plating technique is not inferior to FCL system in terms of final fracture healing, surgery-related complication, and function outcome. Fracture site and presence of open fracture are the independent factors for complications in patients treated with FCL system.