Session VI - Pediatrics / Geriatrics / Hip / Femur / Injury Prevention

Sat., 10/15/11 Peds, Ger, Hip, Femur & IP, Paper #78, 11:26 am OTA-2011

Clinical Outcomes of Locked Plating of Distal Femoral Fractures

Martin F. Hoffmann, MD1; Clifford B. Jones, MD, FACS2,3; Debra L. Sietsema, PhD2,3;
Paul Tornetta, III, MD4; Scott J. Koenig, MD4; Benjamin T. Maatman, BS4;
1Grand Rapids Medical Education Partners, Grand Rapids, Michigan, USA;
2Orthopaedic Associates of Michigan, Grand Rapids, Michigan, USA;
3Michigan State University, Grand Rapids, Michigan, USA;
4Boston University Medical Center, Boston, Massachusetts, USA

Purpose: Locked plating (LP) of distal femoral fractures is very popular. Despite technique suggestions from anecdotal and some early reports, risk factors for failure, nonunion (NU), and revision are limited. The purpose of this study was to investigate the risk factors for failure and to confirm suggested technical recommendations.

Methods: From 2 academic trauma centers, 261 consecutive distal femoral fractures (OTA 33) were retrospectively identified. 133 fractures in 127 patients (56% female) had an average age of 55 years (range, 18-95 years). 40% of the cohort was obese, 18% were smokers, and 20% were diabetic. 35% of the fractures were open, with 76% type III. Fixation constructs for plate length, working length, and screw concentration were delineated. NU, infection, and implant failure were used as independent complication variables. Demographics were assessed.

Results: Nonunion: 100 (75.2%) of the fractures healed after the index procedure. 26 (19.6%) of the patients developed NU. 31 of 133 (23.3%) had staged bone grafting (BG) with 3 of 31 (9.7%) resulting in a recalcitrant NU requiring repeat BG. Length of comminution is related to NU (P = 0.04). Implant Failures: 14 (10.5%) of the patients had an implant failure. Independent variables for implant failure were staged BG (P <0.01) and periprosthetic fractures (P <0.01). Fixation Constructs: No failures occurred with plates with ≥14 proximal holes. A 6-fold higher relative risk of failure is noted utilizing plate lengths of ≤10 holes compared to >11-hole plates (8 of 21 [38.1%] vs 7 of 123 [5.7%]). In the failures, a proximal screw concentration of >70% had a 10-fold relative risk of failure.

Conclusion: Compared to prior reports, demographics were not related to failures of locked plating for distal femoral fractures. Comminuted fractures requiring staged bone grafting were independent risk factors of failure. We recommend plates of ≥14 holes, >10 holes proximal to the fracture, and proximal screw concentration of <70%.

Alphabetical Disclosure Listing (628K PDF)

• 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.