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VOLUME 17 , ISSUE 3 ( September-December, 2022 ) > List of Articles

Original Article

The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates

John Mukhopadhaya, Rajeev Ranjan, Amit Kumar Sinha, Janki Sharan Bhadani

Keywords : Aseptic non-union, Autologous bone grafting, Compression device, Decortication, Distal femur fracture, Distal femur locking plate, Lateral locking plate, Non-union

Citation Information : Mukhopadhaya J, Ranjan R, Sinha AK, Bhadani JS. The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates. 2022; 17 (3):137-143.

DOI: 10.5005/jp-journals-10080-1564

License: CC BY-NC-SA 4.0

Published Online: 30-12-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Distal femoral non-unions are challenging, and frequently associated with short distal fragments, poor bone stock, and with issues from previous implants. Materials and methods: A retrospective study of 31 patients admitted with distal femoral non-unions treated using anatomical lateral locking plates. Non-union scores were used. The Knee Society and Neer’s scores were used for the comparison of results. The mean follow-up was 39.5 months (from 24 months to 60 months). Results: Stable union was accomplished in all. There was a significant improvement in the average Neer’s score (24 preoperative to 82 post-operatively at final follow-up), the Part 1 Knee Society score from an average of 46 preoperatively to 84 post-operatively, and Part 2 Knee Society score from 36 preoperatively to 80 post-operatively. Conclusion: Optimal stability, good compression at the non-union site (either by lag screws or a compression device or both), maintaining the axial alignment strictly, freshening of bone ends, using an adequate amount of cortico-cancellous bone graft, respecting the biology along with the correct choice of the implant (including the size) are essential to achieve union at the fracture site. Clinical significance: Paying attention to the basic principles of management, good contact, stability and maintaining biology is essential in the treatment of non-union.


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  1. Zlowodzki M, Bhandari M, Marek DJ, et al. Operative treatment of acute distal femur fractures: Systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma 2006;20(5):366–371. DOI: 10.1097/00005131-200605000-00013.
  2. Nayak RM, Koichade MR, Umre AN, et al. Minimally invasive plate osteosynthesis using a locking compression plate for distal femoral fractures. J Orthop Surg (Hong Kong) 2011;19(2):185–190. DOI: 10.1177/230949901101900211.
  3. Rodriguez EK, Boulton C, Weaver MJ, et al. Predictive factors of distal femoral fracture nonunion after lateral locked plating: A retrospective multicentre case–control study of 283 fractures. Injury 2014;45(3):554–559. DOI: 10.1016/j.injury.2013.10.042.
  4. Henderson CE, Kuhl LL, Fitzpatrick DC, et al. Locking plates for distal femur fractures: Is there a problem with fracture healing? J Orthop Trauma 2011;25(Suppl. 1):S8–S14. DOI: 10.1097/BOT.0b013e3182070127.
  5. Dyke BV, Colley R, Ottomeyer C, et al. Effect of blocking screws on union of infraisthmal femur fractures stabilized with a retrograde intramedullary Nail. J Orthop Trauma 2018;32(5):251–255. DOI: 10.1097/BOT.0000000000001119.
  6. Yoon BH, Park IK, Kim Y, et al. Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: A meta-analysis. Arch Orthop Trauma Surg 2021;141(2):225–233. DOI: 10.1007/s00402-020-03463-x.
  7. Ebraheim NA, Martin A, Sochacki KR, et al. Nonunion of distal femoral fractures: A systematic review. Orthop Surg 2013;5(1):46–50. DOI: 10.1111/os.12017.
  8. Brinker MR. Nonunions: Evaluation and treatment. In: Trafton PG, editor. Skeletal Trauma: Basic Science, Management, and Reconstruction, 3rd edition. Philadelphia: W.B. Saunders; 2003, p.507–604.
  9. Vaishya R, Singh AP, Hasija R, et al. Treatment of resistant nonunion of supracondylar fractures femur by megaprosthesis. Knee Surg Sports Traumatol Arthrosc 2011;19(7):1137–1140. DOI: 10.1007/s00167-011-1416-1.
  10. Kanakeshwar RB, Jayaramaraju D, Agraharam D, et al. Management of resistant distal femur non-unions with allograft strut and autografts combined with osteosynthesis in a series of 22 patients. Injury 2017;48(Suppl. 2):S14–S17. DOI: 10.1016/S0020-1383(17)30488-6.
  11. Maheshwari P, Maheshwari P. Nonunion distal femur fracture: Causes and management Options. Trauma Int 2016;1(2):28–33. DOI: 10.13107/ti.2016.v02i01.017.
  12. Emara KM, Diab RA, Emara AK. Recent biological trends sin management of fracture non-union. World J Orthop 2015;6(8):623–628. DOI: 10.5312/wjo.v6.i8.623.
  13. de Grado FG, Keller L, Idoux–Gillet Y, et al. Bone substitutes: A review of their characteristics, clinical use, and perspectives for large bone defects management. J Tissue Eng 2018;9:2041731418776819. DOI: 10.1177/2041731418776819.
  14. Wang W, Yeung KWK. Bone grafts and biomaterials substitutes for bone defect repair: A review. Bioact Mater 2017;2(4):224–247. DOI: 10.1016/j.bioactmat.2017.05.007.
  15. Harris NH. Clinical experience with the Müller compression device. Proc R Soc Med 1965;58(11 Part 1):879–882. PMID: 5851529.
  16. Schmidt–Rohlfing B, Pfeifer R, Kaneshige J, et al. Scoring systems for outcome after knee injuries. Injury 2011;42(3):271–275. DOI: 10.1016/j.injury.2010.11.059.
  17. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;(248):13–14. PMID: 2805470.
  18. Calori GM, Phillips M, Jeetle S, et al. Classification of non-union: Need for a new scoring system? Injury 2008;39(Suppl. 2):S59–S63. DOI: 10.1016/S0020-1383(08)70016-0.
  19. Weaver MJ, Chaus GW, Masoudi A, et al. The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures. BMC Musculoskelet Disord 2021;22(1):512. DOI: 10.1186/s12891-021-04341-2.
  20. Bel JC. Pitfalls and limits of locking plates. Orthop Traumatol Surg Res 2019;105(1S):S103–S109. DOI: 10.1016/j.otsr.2018.04.031.
  21. Barber CC, Burnham M, Ojameruaye O, et al. A systematic review of the use of titanium versus stainless steel implants for fracture fixation. OTA Int 2021;4(3):e138. DOI: 10.1097/OI9.0000000000000138.
  22. Martinet O, Cordey J, Harder Y, et al. The epidemiology of fractures of the distal femur. Injury 2000;31(3):62–63. DOI: 10.1016/s0020-1383(00)80034-0.
  23. Lee JA, Papadakis SA, Moon C, et al. Tibial plateau fractures treated with the less invasive stabilisation system. Int Orthopaedic 2007;31(3):415–418. DOI: 10.1007/s00264-006-0176-x.
  24. Ryan JK, Arthur LM, Craig SR, et al. Treatment of bicondylar tibia plateau fractures using locked plating versus external fixation. Orthopedics 2009;32:559–570. DOI: 10.3928/01477447-20090624-11.
  25. Gardner MJ, Toro–Arbelaez JB, Harrison M, et al. Open reduction and internal fixation of distal femoral nonunions: Long-term functional outcomes following a treatment protocol. J Trauma 2008;64(2):434–438. DOI: 10.1097/01.ta.0000245974.46709.2e.
  26. Singh A, Vohra R, Thorat B, et al. Outcomes of distal femur nonnunion following lateral locked plating treated with an addition of a medial locking plate and autogenous bone graft. Orthop Spo Med Op Acc J 2020;4(3):389–397. DOI: 10.32474/OSMOAJ.2020.04.000187.
  27. Haidukewych GJ, Berry DJ, Jacofsky DJ, et al. Treatment of supracondylar femur nonunions with open reduction and internal fixation. Am J Orthop (Belle Mead NJ) 2003;32(11):564–567. PMID: 14653489.
  28. Wang JW, Weng LH. Treatment of distal femoral nonunion with internal fixation, cortical allograft struts, and autogenous bone-grafting. J Bone Joint Surg Am 2003;85(3):436–440. DOI: 10.2106/00004623-200303000-00006.
  29. Bellabarba C, Ricci WM, Bolhofner BR. Indirect reduction and plating of distal femoral nonunions. J Orthop Trauma 2002;16(5):287–296. DOI: 10.1097/00005131-200205000-00001.
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