Hybrid locked medial plating in dual plate fixation optimizes the healing of comminuted distal femur fractures: A retrospective cohort study |
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| Affiliation: | 1. Department of Orthopedics, Shanghai Tenth People''s Hospital, Tongji University School of Medicine, Shanghai, 200072, China;2. Shanghai Trauma Emergency Center, Shanghai, 200072, China;3. Orthopedic Intelligent Minimally Invasive Diagnosis & Treatment Center, Shanghai Tenth People''s Hospital, Tongji University School of Medicine, Shanghai, 200072, China;1. Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences University “La Sapienza”, Piazzale Aldo Moro, Rome 5 00185, Italy;2. Department of Public Health and Infectious Diseases, University “La Sapienza”, Piazzale Aldo Moro, Rome 5 00185, Italy;1. Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital Yuanshan Branch, Taiwan, ROC;2. Department of Orthopaedics; School of Medicine; National Yang-Ming University, Taiwan, ROC;3. Division of Medical Imaging for Health Management, Cheng-Hsin General Hospital, Taiwan, ROC;4. Department of Radiology; School of Medicine; National Yang-Ming University, Taiwan, ROC;5. Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taiwan, ROC;6. Department of Orthopaedics and Traumatology; Taipei Veterans General Hospital, Taiwan, ROC;1. R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA;2. Bay Medical Sacred Heart, Department of Orthopedic Surgery, Panama City, FL, USA;3. Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;4. Brooke Army Medical Center, Department of Orthopaedic Surgery, Fort Sam Houston, TX, USA;1. Sports Injury Center, Ring Road, Safdarjung Enclave, New Delhi 110029, India;2. Promhex Multispecialty Hospital, Omega 1, Greater Noida, Uttar Pradesh, India;3. Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, 13, Bahadur Shah Zafar Marg, New Delhi 110002, India;1. Department of Orthopaedics, HIMSR, New Delhi, India;2. Consultant Orthopaedics, Shalby Hospital, Surat, India;3. Department of Orthopaedics, HIMSR, New Delhi, India |
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| Abstract: | ObjectivesDual plate fixation has been reported to be effective in the treatment of comminuted distal femur fractures (DFFs). However, optimized use of the medial plate and screws is less studied. This study aimed to evaluate the effect of a hybrid configuration of the medial plate in dual plate fixation of comminuted DFFs in promoting fracture healing.Materials and methodsWe retrospectively analyzed 62 patients with comminuted DFFs (AO/OTA 33-A3/33-C2/33-C3) from January 2015 to March 2020, who were either fixed with lateral locked plating augmented with hybrid locked medial plating (LP-HLMP, n = 32) or lateral locked plating (LLP, n = 30) alone. Specifically, compression screws were applied in the middle of the medial plate and flanked by locking ones at both ends. Baseline characteristics, radiological and clinical outcomes were reviewed and analyzed. Multivariate logistic regression analysis was used to identify predictive factors for early fracture healing, and risk factors for delayed union/nonunion.ResultsDemographics including age, gender, smoking, diabetes, and injury mechanism were comparable between the two groups. Reduction quality was better in the LP-HLMP group (p < 0.001). Although the LP-HLMP group experienced longer duration of surgery (125 min vs. 100 min, p < 0.001), sign of healing at 3 months was more obvious in this group (75%, 24/32 vs. 30%, 9/30; p < 0.001). The LP-HLMP group also presented with higher union rate (93.8%, 30/32 vs. 56.7%, 17/30; p = 0.001) and lower reoperation rate (0%, 0/32 vs. 13.3%, 4/30; p = 0.049). Kolment score showed no statistical significance between the two groups. Multivariate analysis revealed that younger age (< 60 years) (OR 5.99, 95%CI 1.16 – 31.03; p = 0.001) and LP-HLMP fixation (OR 45.90, 95% CI 4.78 – 440.56; p = 0.001) predict early healing; while smoking (OR 17.80, 95% CI 2.41 – 131.49; p = 0.01) and fracture translation (OR 3.49, 95% CI 1.46 – 8.32; p = 0.01) were identified as risk factors for delayed union/nonunion.ConclusionHybrid locked medial plating in this study favors the healing of comminuted DFFs and reduces reoperation. Additionally, smoking and suboptimal reduction (translation) predict delayed union/nonunion. |
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