Sat., 10/18/08 Femur, Paper #54, 10:22 am OTA-2008
Complications and Secondary Operations Are Associated with Locked Plating of Distal Femur Fractures
Heather A. Vallier, MD (a-Synthes); Wes Immler (n);
MetroHealth Medical Center, Cleveland, Ohio, USA
Introduction: In the distal femur, locked plates are efficacious when coronal fractures preclude use of conventional fixed-angle devices. However, a clinical comparison of fractures of the distal femur amenable to either device has never been undertaken. The purpose of this study is to compare the 95° angled blade plate (ABP) versus the locking condylar plate (LCP) by assessing clinical and radiographic results, complications, secondary procedures, and functional outcomes.
Methods: Distal femoral fractures (OTA 33A, 33C1, 33C2) amenable to ABP or LCP were retrospectively reviewed, over 6 years when both implants were used by five fellowshiptrained traumatologists at a Level 1 trauma center. 55 patients with a mean age of 58 years (range, 20-90) were included: 23 (42%) with ABP and 32 (58%) with LCP. 10 patients had fractures adjacent to a previous knee arthroplasty (4 ABP, 6 LCP). Patients in both groups were evenly matched with respect to age, fracture pattern, and presence of open fracture. The majority of injuries were the result of high-energy trauma, and 20% were open fractures.
Results: After a minimum of 12 months of follow-up, four patients (7.3%) were treated for infections and four patients (7.3%) were treated for nonunions. The ABP and LCP groups were no different with respect to infection and nonunion. However, complications were more frequent in LCP patients (31.3%) versus ABP patients (9.5%, P = 0.032). Complications were not related to fracture pattern, periprosthetic fracture, or open fracture. Malunions occurred in 9.4% of LCP patients, and in no ABP patients (P = 0.065). All patients with malunions were >55 years of age. Overall, 24.5% of patients underwent secondary procedures including treatment of infection, nonunion, malunion, or prominent hardware removal. Secondary procedures were more common after LCP (32.3%) versus ABP (11.1%, P = 0.048). Painful prominent hardware was removed from four (12.5%) LCP patients and no ABP patients (P = 0.039).
Conclusion and Significance: Distal femur fractures are often associated with prolonged healing and rehabilitation times, which increase substantially when complications occur. Internal fixation of these fractures may be performed successfully with the ABP or LCP. In our review of fractures that could be treated with either implant, patients treated with locked plates had more complications, malunions, and required more secondary procedures to treat complications and to remove prominent hardware. Furthermore, locked plates are substantially more expensive than conventional fixed-angle devices. Future investigation is needed in the form of a large, randomized, prospective study to clearly define clinical differences, functional outcomes, and cost of care.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.