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Background: To compare the biomechanical performance of three internal fixation constructs for AO/OTA 33-A3 distal femoral fractures. Methods: Thirty AO/OTA 33-A3 synthetic distal femoral fracture models were constructed and randomly divided into three groups. Group A (dual-plate construct) was fixed with a medial locking plate combined with a less invasive stabilization system (LISS). Group B was fixed with a retrograde femoral nail (RFN) combined with an LISS (RFN + LISS construct), and Group C was fixed with a retrograde tibial nail (RTN) combined with an LISS (RTN + LISS construct). The axial displacement, axial stiffness, torsional displacement, torsional stiffness and maximum failure load of different internal fixation constructs were recorded and statistically analyzed. Results: In the axial compression test, the average stiffness of Group C was significantly higher than that of Groups A and B, and the average displacement of Group C was significantly smaller than that of Groups A and B. In the torsion test, the torsion degree of Group C was significantly lower than that of Groups A and B, and Group C had a higher torsional stiffness than Groups A and B. In the axial compression failure test, the average ultimate load (a displacement greater than 5 mm) of Group C was significantly higher than that of Groups A and B. Conclusion: The biomechanical strength of the RTN combined with a plate is higher than that of the RFN combined with plate and dual-plate constructs, which can be used as an internal fixation option for the treatment of comminuted distal femoral fractures. [ABSTRACT FROM AUTHOR]

Distal femoral fractures are uncommon in the newborn period, and conventional radiographs can miss the diagnosis in infants born prematurely due to delayed ossification. Hence, modalities like ultrasound may have a role in diagnosis. Herein, we report a male infant born preterm with a swollen knee due to a distal femoral fracture after a non‐traumatic Caesarean section. The fracture was not present on the conventional radiograph. Instead, it was detected on a repeat sonogram and healed spontaneously with no complications. This case describes the importance of musculoskeletal radiographic expertise for diagnosis of this uncommon newborn fracture. [ABSTRACT FROM AUTHOR]

Introduction: Surgical treatment of distal femoral fractures (DFFs) in osteoporotic bone is challenging despite improvements in hardware and surgical techniques. The occurrence and degree of secondary displacement during healing after bridging plate fixation are still unknown. This study aimed to assess the occurrence and degree of secondary displacement in healing DFFs in elderly patients and correlate the secondary displacement to body mass index, bone density, and weight-bearing regimen. Patients and Methods: The study involved 32 patients, 65 years or older, with a DFF of AO/OTA types 33 A2-3, B1-2, C1-2, and 32(c) A-C,1-3, including peri-prosthetic fractures with stable implants. Twenty-seven patients had at least 8 weeks of follow-up, and 21 patients had a complete 1-year follow-up. Minimally invasive surgery was performed using a distal anatomical femoral plate as a long bridge-plating construct. Secondary displacement was assessed with computed tomography of the entire femur postoperatively and at 8, 16, and 52 weeks. Femoral length, coronal angulation (varus/valgus), and subsidence as the change in distance between the distal joint surface and a specified locking screw were measured. Results: There was a statistically significant mean femoral shortening at 52 weeks of 4.7 mm (SD 3.9, (95% CI 2.9–6.5), P < 0.001) mainly by subsidence of the distal fragment. Most patients experienced limited coronal angulation. There was no correlation between body mass index or bone density and secondary displacement. At the 1-year follow-up, no patient needed revision surgery for non-union or plate breakage. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or adverse events such as cut-outs. Conclusion: Modern dynamic plate osteosynthesis could not prevent commonly occurring fracture subsidence in DFF in an elderly cohort. Restricted weight-bearing for 8 weeks did not prevent secondary displacements or mechanical adverse events. [ABSTRACT FROM AUTHOR]

Abstract Background Distal femoral fractures account for less than 1% of all fractures. The therapy of choice is usually surgical stabilization. Despite advances in implant development over the past few years, complication rate remains comparatively high. The aim of this study is to analyze our results with plate fixation of distal femoral fractures with a focus on complication and fracture healing rates. Methods In this retrospective cohort study, patients (> 18 years) with distal femoral fractures treated at an urban level I trauma center between 2015 and 2022 were analyzed. Results In total, 206 patients (167 female, 39 male) with an average age of 75 (SD 16) years were diagnosed with a fracture of the distal femur. One hundred fourteen of these patients were treated surgically by means of plate osteosynthesis. In 13 cases (11.41%), a revision procedure had to be performed. The indication for surgical revision was mechanical failure in eight cases (7.02%) and septic complication in five cases (4.39%). Periprosthetic fractures were more likely to cause complications overall (19.6% versus 4.76%) and further included all documented septic complications. The analysis of modifiable surgical factors in the context of plate osteosynthesis showed higher complication rates for cerclage in the fracture area compared with plate-only stabilizations (44.44% versus 22.22%). Conclusions The data show an increased amount of revisions and a significantly higher number of septic complications in the treatment of periprosthetic fractures of the distal femur compared with non-periprosthetic fractures. The detected combination of plates together with cerclage was associated with higher complication rates. Level of evidence Level III retrospective comparative study.

Background: Distal femoral fractures account for less than 1% of all fractures. The therapy of choice is usually surgical stabilization. Despite advances in implant development over the past few years, complication rate remains comparatively high. The aim of this study is to analyze our results with plate fixation of distal femoral fractures with a focus on complication and fracture healing rates. Methods: In this retrospective cohort study, patients (> 18 years) with distal femoral fractures treated at an urban level I trauma center between 2015 and 2022 were analyzed. Results: In total, 206 patients (167 female, 39 male) with an average age of 75 (SD 16) years were diagnosed with a fracture of the distal femur. One hundred fourteen of these patients were treated surgically by means of plate osteosynthesis. In 13 cases (11.41%), a revision procedure had to be performed. The indication for surgical revision was mechanical failure in eight cases (7.02%) and septic complication in five cases (4.39%). Periprosthetic fractures were more likely to cause complications overall (19.6% versus 4.76%) and further included all documented septic complications. The analysis of modifiable surgical factors in the context of plate osteosynthesis showed higher complication rates for cerclage in the fracture area compared with plate-only stabilizations (44.44% versus 22.22%). Conclusions: The data show an increased amount of revisions and a significantly higher number of septic complications in the treatment of periprosthetic fractures of the distal femur compared with non-periprosthetic fractures. The detected combination of plates together with cerclage was associated with higher complication rates. Level of evidence Level III retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background and Objectives: The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the stability of osteosynthesis. Nevertheless, metal corrosion and the allergenic potency of steel remain problematic disadvantages of this method. A biomechanical study was carried out to evaluate titanium cable cerclage as an alternative supplement for plate osteosynthesis of a distal femoral two-part fracture. Materials and Methods: An unstable AO/OTA 32-A2.3 fracture was created in eleven pairs of nonosteoporotic human cadaver femora. All the samples were treated with polyaxial angular stable plate osteosynthesis. One femur from each pair was randomly selected for an additional fracture fixation with multifilament titanium cable cerclage. Stepwise cyclic axial loading was applied in a load-to-failure mode using a servohydraulic testing machine. Results: All specimens (mean age: 80 years; range: 57–91 years) withstood a cycling force of at least 1800 N. With a mean load of 2982 N (95% CI: 2629–3335 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimens with an additional titanium cerclage (Group 1) than in samples that were solely treated with plate osteosynthesis (Group 2) at 2545 N (95% CI: 2257–2834 N) (p = 0.024). In both groups, cutting out the distal screws at the condyle region, resulting in shearing of the distal fragment proximal to the fracture line, was the most frequent cause of construct failure. Among the specimens assigned to Group 1, 36% exhibited a specific fracture pattern, namely, a fracture of the dorsal buttress above the cerclage. Analysis of axial stiffness (p = 0.286) and irreversible deformity of the specimens revealed no differences between the groups (p = 0.374). Conclusion: Titanium cable cerclage application, as a supplement to an angular stable plate, resulted in an increased load to failure. In terms of stability, the use of this adjunct for fracture fixation of supracondylar two-part oblique femoral fractures might, therefore, be an option, especially in patients who are sensitive to nickel. [ABSTRACT FROM AUTHOR]

Purpose: The distal femur comprises a wide intramedullary cavity and thin cortical bone. Firm internal fixation of comminuted fractures with displacement is challenging. Although many comparative studies have reported retrograde intramedullary nailing (RIN) and distal femoral plating (DFP) as the usual fixation methods for distal femoral fractures, no clear conclusion has been reached. Therefore, a meta-analysis and systematic review of the clinical and radiological results were conducted to determine the appropriate treatment method for distal femoral fractures. Methods: A systematic search of the PubMed, Embase, Scopus, and Cochrane Library databases from their inception to December 19, 2022, was performed using predefined criteria. Studies comparing the effects of RIN and DFP were considered. The analyzed outcome measures included duration of surgery, blood loss, time to union, delayed union, nonunion, malalignment, implant failure, infection, reoperation, limb length discrepancy, range of motion, persistent anterior knee pain, knee stiffness, and functional scores. Meta-analysis of pooled data was conducted using a random-effects model to determine the standard mean difference (SMD) or odds ratio (OR) with 95% confidence intervals (CIs). Results: Thirty-three studies with 2,432 patients were included. Compared to DFP, RIN was associated with a shorter time to fracture union (SMD, 1.83 months; 95% CI − 2.76 to − 0.90; P < 0.001) and a lower incidence of postoperative infection (OR 0.54; 95% CI 0.31–0.94; P = 0.03). Pooled analysis revealed no significant differences in other outcome measures between the two treatment modalities. Conclusion: In distal femoral fractures, RIN had a shorter bone union time and was more resistant to infection than DFP. However, there were no significant differences in the other clinical parameters. Therefore, the characteristics, strengths, and weaknesses of RIN and DFP should be carefully identified, and appropriate treatment should be provided based on the patient's medical condition and fracture pattern. [ABSTRACT FROM AUTHOR]

Dual plating of comminuted distal femoral fractures allows for early patient mobilization. An additional helically shaped medial plate avoids the medial vital structures of the thigh. The aim of this study is to investigate the biomechanical competence of an augmented lateral locking compression plate distal femur (LCP‐DF) using an additional straight versus a helically shaped medial LCP of the same length. Ten pairs of human cadaveric femora were instrumented with a lateral anatomical 15‐hole LCP‐DF. Following, they were pairwise instrumented with either an additional medial straight 14‐hole LCP (group 1) or a 90°‐helical shape LCP (group 2). All specimens were biomechanically tested under quasi‐static and progressively increasing combined cyclic axial and torsional loading until failure. Initial interfragmentary axial displacement and flexion under static compression were significantly smaller in group 1 (0.11 ± 0.12 mm and 0.21 ± 0.10°) versus group 2 (0.31 ± 0.14 mm and 0.68 ± 0.16°), p ≤ 0.007. Initial varus deformation under static compression remained not significantly different between group 1 (0.57 ± 0.23°) and group 2 (0.75 ± 0.34°), p = 0.085. Flexion movements during dynamic loading were significantly bigger in group 2 (2.51 ± 0.54°) versus group 1 (1.63 ± 1.28°), p = 0.015; however, no significant differences were observed in terms of varus, internal rotation, and axial and shear displacements between the groups, p ≥ 0.204. Cycles to failure and load at failure were higher in group 2 (25,172 ± 6376 and 3017 ± 638 N) compared to group 1 (22,277 ± 4576 and 2728 ± 458 N) with no significant differences between them, p = 0.195. From a biomechanical perspective, helical double plating may be considered a useful alternative to straight double plating, demonstrating ameliorated damping capacities during flexion deformation and safer application as the medial neurovascular structures of the thigh are avoided. [ABSTRACT FROM AUTHOR]

This case report details the management of low-velocity gunshot wounds (GSWs) in a 28-year-old man, emphasizing the distinctive challenges and treatment strategies in urban civilian settings. This study contributes to medical literature by providing insights into the complexities of treating atypical fractures caused by GSWs, especially involving nonstandard ammunition. The patient, involved in an urban gunfight, sustained multiple low-velocity GSWs to his lower limbs. The diagnoses included an atypical intra-articular fracture in the left distal femur and a foreign body in the right lower leg. Treatment involved emergency surgery with K-wire stabilization for the left femur fracture and exploratory surgery for the right leg. No foreign bodies were found in the right leg, but subsequent analysis revealed pseudo-encapsulated calcification, indicative of previous fat necrosis. In 15 days after the initial trauma, the final surgical intervention took place, during which a low-contact condylar plate was placed on the left distal femur. Postoperative recovery was successful, with the patient regaining full mobility and range of motion after one year. Low-velocity GSWs in civilian settings can result in complex atypical fractures requiring specialized surgical intervention and management.

Background: To compare the biomechanical performance of three internal fixation constructs for AO/OTA 33-A3 distal femoral fractures. Methods: Thirty AO/OTA 33-A3 synthetic distal femoral fracture models were constructed and randomly divided into three groups. Group A (dual-plate construct) was fixed with a medial locking plate combined with a less invasive stabilization system (LISS). Group B was fixed with a retrograde femoral nail (RFN) combined with an LISS (RFN + LISS construct), and Group C was fixed with a retrograde tibial nail (RTN) combined with an LISS (RTN + LISS construct). The axial displacement, axial stiffness, torsional displacement, torsional stiffness and maximum failure load of different internal fixation constructs were recorded and statistically analyzed. Results: In the axial compression test, the average stiffness of Group C was significantly higher than that of Groups A and B, and the average displacement of Group C was significantly smaller than that of Groups A and B. In the torsion test, the torsion degree of Group C was significantly lower than that of Groups A and B, and Group C had a higher torsional stiffness than Groups A and B. In the axial compression failure test, the average ultimate load (a displacement greater than 5 mm) of Group C was significantly higher than that of Groups A and B. Conclusion: The biomechanical strength of the RTN combined with a plate is higher than that of the RFN combined with plate and dual-plate constructs, which can be used as an internal fixation option for the treatment of comminuted distal femoral fractures.

Background: This study aimed to assess differences in implant failure and bone union rates, amount of change in alignment of lower extremities, and walking ability between early weight-bearing (EWB) and late weight-bearing (LWB) groups following retrograde intramedullary nailing (RIMN) for distal femoral fracture (AO/OTA 33) (DFF) at multiple centers using propensity score matching.Methods: The data of 213 patients who underwent RIMN from 2012 to 2019 in multiple tertiary hospitals were extracted from our database. Cases with the following factors were excluded: age <60, open fracture, AO/OTA-type 33-C3 fracture, preoperative New Mobility Score (NMS) < 3, postoperative follow-up <3 months, and unknown weight-bearing start time. Eighty-four patients were divided into the EWB and LWB groups. EWB group patients were encouraged to perform partial weight-bearing walking at ≤4 weeks after surgery. LWB group patients were not allowed weight bearing for >4 weeks after surgery. After propensity score matching was applied, 26 cases remained in each group.Results: There were no cases of nail failure in either the EWB group or LWB group (P = 1). Screw failure occurred in 0 cases in the EWB group and in 1 case (4.5%) in the LWB group (P = 1.0). Non-union occurred in 5 patients (19.2%) in the EWB group and 4 patients (15.3%) in the LWB group (P = 1). The mean amount of change in lower extremities alignment did not differ between the two groups. The median Knee Society Score was 95.5 (59-100) vs. 93 (72-100) points (P = 0.39). The median NMS was 7 (0-9) vs. 7 (4-9) points (P = 0.82).Conclusions: There were no significant intergroup differences in the rates of implant failure, bone union at one year after surgery, amount of change in lower extremities alignment, or walking ability. We suggest that early weight bearing after RIMN for DFF may not be harmful in elderly people. [ABSTRACT FROM AUTHOR]

For complex distal femoral fractures, a single lateral locking compression plate or retrograde intramedullary nail may not achieve a stable environment for fracture healing. Various types of double fixation constructs have been featured in the current literature. Double-plate construct and nail-and-plate construct are two common double fixation constructs for distal femoral fractures. Double fixation constructs have been featured in studies on comminuted distal femoral fractures, distal femoral fracture with medial bone defects, periprosthetic fractures, and distal femoral non-union. A number of case series reported a generally high union rate and satisfactory functional outcomes for double fixation of distal femoral fractures. In this review, we present the state of the art of double fixation constructs for distal femoral fractures with a focus on double-plate and plate-and-nail constructs.

Background and Objectives: The reduction of two-part oblique or spiral fractures of the distal femur using steel wire cerclage prior to plate osteosynthesis is a proven procedure. In addition to being useful in fracture reduction, wire cerclage was also shown to increase the stability of osteosynthesis. Nevertheless, metal corrosion and the allergenic potency of steel remain problematic disadvantages of this method. A biomechanical study was carried out to evaluate titanium cable cerclage as an alternative supplement for plate osteosynthesis of a distal femoral two-part fracture. Materials and Methods: An unstable AO/OTA 32-A2.3 fracture was created in eleven pairs of nonosteoporotic human cadaver femora. All the samples were treated with polyaxial angular stable plate osteosynthesis. One femur from each pair was randomly selected for an additional fracture fixation with multifilament titanium cable cerclage. Stepwise cyclic axial loading was applied in a load-to-failure mode using a servohydraulic testing machine. Results: All specimens (mean age: 80 years; range: 57–91 years) withstood a cycling force of at least 1800 N. With a mean load of 2982 N (95% CI: 2629–3335 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimens with an additional titanium cerclage (Group 1) than in samples that were solely treated with plate osteosynthesis (Group 2) at 2545 N (95% CI: 2257–2834 N) (p = 0.024). In both groups, cutting out the distal screws at the condyle region, resulting in shearing of the distal fragment proximal to the fracture line, was the most frequent cause of construct failure. Among the specimens assigned to Group 1, 36% exhibited a specific fracture pattern, namely, a fracture of the dorsal buttress above the cerclage. Analysis of axial stiffness (p = 0.286) and irreversible deformity of the specimens revealed no differences between the groups (p = 0.374). Conclusion: Titanium cable cerclage application, as a supplement to an angular stable plate, resulted in an increased load to failure. In terms of stability, the use of this adjunct for fracture fixation of supracondylar two-part oblique femoral fractures might, therefore, be an option, especially in patients who are sensitive to nickel.

Abstract Background Locking plates are commonly used in the treatment of comminuted metaphyseal distal femoral fractures. However, locking plates form a strong structure and promote asymmetrical callus formation, which is not conducive for rapid fracture healing and may increase fracture risk. To overcome this, we designed a micromotion-balancing fixation system based on locking plates. Methods Six healthy pigs (Bama miniature pigs) were used to establish a model of bilateral comminuted distal femoral fracture (AO/ASIF: 33-C2). Standard drilling was performed on one of each pig’s hind limbs (control group), whereas eccentric drilling was performed on the other hind limb (experimental group). Both femurs were fixed with a 3-hole locking compression plate using 5-mm-diameter screws. At 12 postoperative weeks, all pigs were euthanized and the femurs with compression plates were radiographically examined. The level of fracture healing and loosening/internal fixation failure were recorded. Bone mineral density, number of trabeculae, trabecular morphology, and calcification precipitations were assessed. Results All pigs survived, and the fractures healed. No complications related to fracture healing, such as infection and internal fixation failure, were noted. The bone mineral density of the near and far cortical calli, number of the near and far cortical callus trabeculae, and difference in bone mineral density between the near and far cortical calli in the experimental group were significantly higher than those in the control group (p

Fractures of the distal femur in young populations are usually due to a high-energy trauma mechanism. They often present with various associated osseous and soft tissue injuries. A case of bilateral open distal femur fractures with associated bilateral quadriceps tendon rupture is presented. This injury has not been previously reported in the literature. A 45-year-old male patient who sustained an axial injury to both his lower limbs after jumping from his house balcony while escaping a fire is presented. He was found to have bilateral open fractures of the distal femurs, associated with bilateral rupture of the quadriceps tendons. Both fractures were repaired via open reduction internal fixation using plate osteosynthesis. The quadriceps tendons were also repaired. Two years later, a persistent right femur nonunion was managed surgically with a re-do plate osteosynthesis and mesenchymal cell injection. The patient is in a good clinical condition after a follow-up of 5 years postoperatively. Rupture of the quadriceps tendon in association with distal femur fractures is a rare finding. However, understanding the mechanics and deforming forces of the fracture is crucial to explain the tendon injury. Open reduction internal fixation with primary repair of the quadriceps has led to successful outcomes in both lower limbs, with restoration of the patient’s baseline of motion and daily living.

Background: Locking plates are commonly used in the treatment of comminuted metaphyseal distal femoral fractures. However, locking plates form a strong structure and promote asymmetrical callus formation, which is not conducive for rapid fracture healing and may increase fracture risk. To overcome this, we designed a micromotion-balancing fixation system based on locking plates. Methods: Six healthy pigs (Bama miniature pigs) were used to establish a model of bilateral comminuted distal femoral fracture (AO/ASIF: 33-C2). Standard drilling was performed on one of each pig's hind limbs (control group), whereas eccentric drilling was performed on the other hind limb (experimental group). Both femurs were fixed with a 3-hole locking compression plate using 5-mm-diameter screws. At 12 postoperative weeks, all pigs were euthanized and the femurs with compression plates were radiographically examined. The level of fracture healing and loosening/internal fixation failure were recorded. Bone mineral density, number of trabeculae, trabecular morphology, and calcification precipitations were assessed. Results: All pigs survived, and the fractures healed. No complications related to fracture healing, such as infection and internal fixation failure, were noted. The bone mineral density of the near and far cortical calli, number of the near and far cortical callus trabeculae, and difference in bone mineral density between the near and far cortical calli in the experimental group were significantly higher than those in the control group (p < 0.01). However, the difference in the number of trabeculae between the near and far cortical calli was significantly lower in the experimental group than in the control group (p < 0.01). Conclusion: This newly designed system provides stable fixation for comminuted distal femoral fracture, increases the overall strain at the fracture site, and balances the strains at the near and far cortices to achieve uniform callus growth and fracture healing. [ABSTRACT FROM AUTHOR]

Background: A research investigation aimed to assess the functional outcomes achieved through the application of locking compression plates for the treatment of OTA type-C distal femoral fractures. These particular fractures constitute approximately 6.97% of all femoral fractures. The aim of this study is to evaluate the outcomes of locking compression plates in treating distal femur fractures. Method: Longitudinal prospective study which included a total of 170 patients, comprising both male and female individuals, underwent treatment for distal femoral fractures using locking compression plates. Various parameters including the cause of the wound, affected portion, subtype of fracture, and treatment outcomes were meticulously noted for analysis. Result: Amongst the 170 patients, 89 of them were males and 81 of them were females. Notably, the leading cause of injury was falls in 38 cases and other causes in 20 cases. In terms of fracture subtypes, there were 70 cases of C1, 60 cases of C2, and 40 cases of C3. When considering laterality, 74 patients had left-sided fractures, while 96 had right-sided fractures. Importantly, these dissimilarities were found to be of statistical significance (P

Although there are some reports highlighting the applicability of double plates in distal femoral fractures, there is no standard approach or fixation method for supracondylar fractures combined with posterior coronal shear fractures. We report a case of distal femoral fracture treated with a lateral locking plate and posterior buttress plate using anterolateral and posterolateral approaches from one incision.A 70-year-old man was hit by a motorcycle and had an intra-articular distal femoral fracture involving a long medial proximal spike and a single lateral condyle fragment, with the lateral condyle fragment posteriorly displaced. A 12-cm lateral skin incision was made, and the joint was developed using a para-patellar approach from the anterior to iliotibial band. Posterior buttress plate fixation was successfully performed from behind the iliotibial band using a posterolateral approach, followed by cannulated cancellous screw and lateral locking plate fixation from the anterolateral window.Combined anterolateral and posterolateral approaches from one incision enable intra-articular exposure and fixation based on fixation principles for lateral condyle fragments combined with supracondylar fracture.

Purpose: Nonunion is a common complication after a distal femoral fracture (DFF). Standard treatment consists of revision plating and/or bone grafting. Single lateral plating for a distal femoral nonunion can be insufficient in case of a persistent medial gap and compromised bone stock. Alternatively, dual plating can be used to treat a distal femoral nonunion, but to date there is no Gold standard. The aim of our study was to report our results after use of a minimally invasively placed proximal humeral internal locking system (Philos) plate as a medial buttress in the treatment of a distal femoral nonunion. Methods: Fifteen adult patients with a distal femoral nonunion were prospectively entered in a trauma database and retrospectively assessed. All patients underwent a similar operation, which included removal of failed hardware, nonunion debridement, fixation with a lateral plate, and a medial Philos plate combined with bone grafting. Data collected included union rate, time to union, complications and functional outcome. Results: In twelve out of fifteen patients (80%), the fracture united after our index operation. Median time to union was 4.8 months (range 1.6–15). Three patients (20%) needed additional bone grafting surgery. One patient underwent a Judet quadricepsplasty. Conclusion: This study suggests that the Philos plate is a safe and effective adjunct as a medial buttress plate for distal femoral nonunions. [ABSTRACT FROM AUTHOR]

Distal femoral fractures in elderly or osteoporotic patients constitute a challenging injury, especially in the settings of fracture comminution or periprosthetic fractures. A recent trend in the treatment of these difficult injuries is the double fixation with a nail and a plate, a strategy that comes with advantages including faster weight-bearing and lower risk for non-union. Although biomechanical studies have demonstrated the superiority of nail-plate constructs, there is a paucity in the literature regarding the indications and results of treatment. A review of the literature to date was carried out to identify which group of patients would benefit the most from this type of reconstruction and to evaluate the clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: The most frequent injuries are lower limb fractures because road traffic accidents, which are the main cause of trauma, are occurring more frequently worldwide. Recent developments and the creation of newer fixation techniques have produced promising results in the treatment of complex lower limb fractures thanks to a better understanding of fracture healing. In our study, we treat lower limb fractures with a novel plate fixation method known as biological plate fixation-bridge plating. The two major fracture fragments are fixed by using the plate as an internal fixator. Without affecting the intricate fracture zone, length, alignment, and rotation are restored. In this case, as opposed to the traditional plating method, the fracture is healed by callus formation. Material and Methods:This study was done both Retrospectively and prospectively in the Department of Orthopaedics and Trauma Centre in J. A. Group of Hospitals, Gwalior. The aim of this study is to assess the clinical and radiological functional outcome of distal femoral both extraarticular and intraarticular fractures types(A,B,C) treated with locking compression plate. We have studied 60 cases of distal femur fractures. Results: out of 60 patients, 22 had excellent, 26 had good and 6 had fair outcome. 12 patients had limb length discrepancy and 20 patients had extension lag. six patient had valgus deformity and six patients had varus deformity. Conclusion: It provides better fixation of fracture in elderly patient with osteoporosis. Post operative early passive mobilisation of the knee gives good range of motion. Operative time is lessened as the locking compression is pre contoured and does not require anatomical fracture reduction. [ABSTRACT FROM AUTHOR]

Aims Postoperative malalignment of the femur is one of the main complications in distal femur fractures. Few papers have investigated the impact of intraoperative malalignment on postoperative function and bone healing outcomes. The aim of this study was to investigate how intraoperative fracture malalignment affects postoperative bone healing and functional outcomes. Methods In total, 140 patients were retrospectively identified from data obtained from a database of hospitals participating in a trauma research group. We divided them into two groups according to coronal plane malalignment of more than 5°: 108 had satisfactory fracture alignment (< 5°, group S), and 32 had unsatisfactory alignment (> 5°, group U). Patient characteristics and injury-related factors were recorded. We compared the rates of nonunion, implant failure, and reoperation as healing outcomes and Knee Society Score (KSS) at three, six, and 12 months as functional outcomes. We also performed a sub-analysis to assess the effect of fracture malalignment by plates and nails on postoperative outcomes. Results The rates of nonunion and reoperation in group U were worse than those in group S (25.0% vs 14.3%; 15.6% vs 5.6%), but the differences were not significant (p = 0.180 and p = 0.126, respectively). Mean KSS in group U at all follow-up periods was significantly worse that in group S (75.7 (SD 18.8) vs 86.0 (SD 8.7); p < 0.001; 78.9 (SD 17.2) vs 89.1 (SD 9.8); p < 0.001; 85.0 (SD 11.9) vs 91.1 (SD 7.2); p = 0.002, respectively). In the sub-analysis of plates, mean KSS was significantly worse in group U at three and six months. In the sub-analysis of nails, the rate of reoperation was significantly higher in group U (28.6% vs 5.8%; p = 0.025), and mean KSS at six and 12 months was significantly worse in Group U. Conclusion To obtain good postoperative functional results, intraoperative alignment of the coronal plane should be accurately restored to less than 5°. Cite this article: Bone Jt Open 2022;3(2):165–172.

Abstract Introduction We evaluated the radiologic and clinical outcomes of a lateral incision single plate with and a single-incision double plating in elderly patients with osteoporotic distal femoral fractures. Materials and methods We performed a retrospective study of 82 cases of distal femoral fractures from May 2004 to June 2018. Group A consisted of 42 patients who underwent single-plate fixation. Group B consisted of 40 patients who underwent double-plate fixation. The mean patient age was 77 years (67–87 years) and 76 years (64–86 years) in groups A and B, respectively. All patients were evaluated for procedure duration, time to union, range of knee motion, Lysholm knee score, and presence of complications. Results The average procedure time was 81 min (66–92 min) and 110 min (95–120 min) in groups A and B, respectively (p = 0.33). One case in group B required bone grafting after 5 months. The average time to union was 14 weeks (9–19 weeks) and 12.2 weeks (8–19 weeks) (p = 0.63), and the mean range of knee motion was 105° (90–125°) and 110.7° (90°–130°) (p = 0.37) in groups A and B, respectively. There was no significant statistical difference between the two groups in the Lysholm knee score (p = 0.44) and knee society score (p = 0.53). Conclusion The clinical and radiological outcomes were similar in the 2 groups. In elderly patients, double plate fixation for distal femoral fractures is an useful method for several advantages such as adequate exposure, easy manipulation, anatomical reduction and stable fixation.

Purpose: This study aimed to evaluate the outcomes of dual plating for unstable distal femoral fractures via a subgroup analysis between periprosthetic and non-periprosthetic fractures.Methods: This retrospective cohort study analyzed the outcomes of dual plating for unstable distal femoral fractures among 49 consecutive patients (43 women and 6 men) enrolled from July 2008 to August 2020. The patients were divided into periprosthetic (group P, n = 29) and non-periprosthetic (group N, n = 20) groups. The radiographic outcomes included the mechanical lateral distal femoral angle (mLDFA) and union rate based on the computed tomography findings. The clinical parameters included the knee range of motion and knee society score (KSS).Results: The mean patient age was 71.1 years, and the average follow-up period was 37 months (range, 12-138 months). Union was achieved in 47 patients (96%). The average final mLDFA was 90.5° in group P and 88.3° in group N. The average final knee range of motion was 130° in group P and 107° in group N. The average final KSS was 73.8 in group P and 87.1 in group N.Conclusion: Dual plating for distal femoral fractures yielded an excellent union rate and limb alignment with a low complication rate. [ABSTRACT FROM AUTHOR]

Background: Management of distal femoral fractures remains a real challenge due to the involvement of unique and vital anatomical structures. These are usually treated with operative measures. Distal femoral locking compression plate (DF-LCP) has gained popularity due to favorable biological insertion and minimal periosteal damage, but locally little is known about it. Therefore, the present study aimed to identify the functional outcomes after fixation of distal femoral fractures with DF-LCP. Methodology: This prospective cohort study, including 21 patients with distal femoral fractures, was conducted at Abbasi Shaheed Hospital from Jan 1, 2017, to Dec 31, 2018. All enrolled patients were treated with DF-LCP. The postoperative clinical and radiological outcomes were evaluated for one year. The data were statistically analyzed using SPSS version 22.0. Results: There were 21 patients with distal femur fractures with a mean age of 46.6 ± 19.2 years. The majority of the fractures were due to road traffic accidents (RTA), i.e., 57.1%, followed by ground-level fall (33.3%). The mean time for fracture union was 20.2 ± 11.1 weeks, and the mean range of motion of the knee was 108.5 ± 18.5º (at one-year follow-up). The complications were minimal; superficial infection and stiffness of knee joint were observed in 2 patients each while there was 1 case each of non-union, delayed union, and implant failure. Conclusion: DF-LCP is an effective treatment for distal femoral fractures as it permits stable fixation and early mobilization. Satisfactory to excellent functional and radiological outcomes were achieved.

In an aging society, the number of femoral fractures is increasing, as well as the incidence of periprosthetic fractures. These secondary fractures are often difficult to fixate stably because of the osteoporotic bone and the existence of the former implant. Herein, we present two cases of secondary femoral shaft fractures after osteosyntheses for distal femur fractures with polyaxial locking plates (Non-Contact-Bridging Distal Femur, NCB-DF®, ZimmerBIOMET, Winterthur, Switzerland). Antegrade intramedullary nails (Natural Nail®-GT Femoral, ZimmerBIOMET, Winterthur, Switzerland) were utilized without removal of the NCB-DFs. In these osteosyntheses, proximal locking screws of NCB-DFs were inserted and locked into the distal inter-locking holes of Natural Nails. This “nail-plate docking technique” could allow for more stable fixation of the whole femur with minimally invasive surgical intervention while preserving the existing implant. Although there are a few surgical technical knacks and pitfalls in inserting the screw, further fractures of the femur could also be prevented with this technique.

Case: We herein present a case involving a 23-year-old man with an open fracture of the distal portion of the left femoral diaphysis, substantial bone loss, and soft tissue injuries. He was initially treated with antibiotics, limb stabilization, and surgical debridement. On the sixth day, he underwent internal fixation and fibular strut graft placement for bone defect restoration. After 4 years, osteosynthesis, perfect graft integration and consolidation, excellent knee functionality, and painless gait were evident. Conclusion: Preservation of bone and soft tissue vitality, complete debridement, antibiotic therapy, and early limb stabilization are all crucial factors for restoring knee functionality.

Fractures of the supracondylar and intercondylar region of the distal femur usually result from high velocity injury that is uncommonly associated with violation of the integrity of the extensor mechanism. The consequences of missed quadriceps injury associated with a distal femur fracture are devastating. The present case report illustrates the importance of recognizing the rare association of quadriceps tear with distal femoral fractures, an appropriate surgical approach to repair the tear as well as fixation of fracture, and a protocol of postoperative rehabilitation to achieve a successful outcome.

Objective: To determine the functional outcome of minimally invasive plating osteosynthesis (MIPO) for distal femur fractures. Study Design: Description Study. Setting: Orthopedic Department of Allied Hospital, Faisalabad. Period: August 2020 to February 2021. Material & Methods: 115 patients of both gender with age ranging from 18 to 50 years and having lower 1/3 femur shaft fractures. Patients having nerve, vascular injury and opened fracture were excluded. All patients were treated with minimally invasive plating osteosynthesis (MIPO). Criteria for bone union was bridging callus formation across the fracture site in antero-posterior and lateral knees x-rays without evidence of loosening breakage and migration of the implants with painless weight bearing on that lower limb. IKDC score at 12 weeks after the procedure was used to assess the functional & clinical outcome. Results: These were excellent function result seen in 65 (56.51%) patients, good in 32 (27.83%), fair in 11 (9.57%) and poor out come in 07 (6.09%). 105 (91.30%) patients with distal 1/3 femur shaft fracture had achieved the union. Conclusion: Our study concluded minimally invasive plating osteosynthesis (MIPO) is an excellent method for the treatment of distal femoral shaft fractures. [ABSTRACT FROM AUTHOR]

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur. Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially. Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint. Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =

Abstract Background There remain limited data on the epidemiological characteristics and related predictors of surgical site infection (SSI) after open reduction and internal fixation (ORIF) for distal femur fractures (DFFs). We designed this single-centre prospective study to explore and forecast these clinical problems. Methods From October 2014 to December 2018, 364 patients with DFFs were treated with ORIF and followed for complete data within one year. Receiver operating characteristic (ROC) analyses, univariate Chi-square analyses, and multiple logistic regression analyses were used to screen the adjusted predictors of SSI. Results The incidence of SSI was 6.0 % (22/364): 2.4 % (9/364) for superficial SSIs and 3.6 % (13/364) for deep SSIs. Staphylococcus aureus (methicillin-resistant S. aureus in 2 cases) was the most common pathogenic bacteria (36.8 %,7/19). In multivariate analysis, parameters independently associated with SSI were: Open fracture (OR: 7.3, p = 0.003), drain use (OR: 4.1, p = 0.037), and incision cleanliness (OR: 3.5, p = 0.002). An albumin/globulin (A/G) level ≥ 1.35 (OR: 0.2, p = 0.042) was an adjusted protective factor for SSI. Conclusions The SSI after ORIF affected approximately one in 15 patients with DFFs. The open fracture, drain use, high grade of intraoperative incision cleanliness, and preoperative A/G levels lower than 1.35 were significantly related to increasing the risk of post-operative SSI after DFFs. We recommended that more attentions should be paid to these risk factors during hospitalization. Trial registration NO 2014-015-1, October /15/2014, prospectively registered. We registered our trial prospectively in October 15, 2014 before the first participant was enrolled. This study protocol was conducted according to the Declaration of Helsinki and approved by the Institutional Review Board. The ethics committee approved the Surgical Site Infection in Orthopaedic Surgery (NO 2014-015-1). Data used in this study were obtained from the patients who underwent orthopaedic surgeries between October 2014 to December 2018.

Abstract Background Given the increasing number of osteoporotic fractures of the distal femur, screw augmentation with bone cement is an option to enhance implant anchorage. However, in implant removal or revision surgeries, the cement cannot be removed from the distal femur without an extended surgical procedure. Therefore, the aims of this study were to investigate (1) whether cement augmentation has any influence on screw removal and removal torque, and (2) whether the implantation of a femoral component of a knee arthroplasty and its initial interface stability are affected by the remaining screws/cement. Material and methods Eight pairs of fresh-frozen human female cadaveric distal femurs (mean age, 86 years) with a simulated AO/OTA 33 A3 fracture were randomized in paired fashion to two groups and fixed with a distal femoral locking plate using cannulated perforated locking screws. Screw augmentation with bone cement was performed in one of the groups, while the other group received no screw augmentation. Following biomechanical testing until failure (results published separately), the screws were removed and the removal torque was measured. A femoral component of a knee arthroplasty was then implanted, and pull-out tests were performed after cement curing. Interference from broken screws/cement was assessed, and the maximum pull-out force was measured. Results The mean screw removal torque was not significantly different between the augmented (4.9 Nm, SD 0.9) and nonaugmented (4.6 Nm, SD 1.3, p = 0.65) screw groups. However, there were significantly more broken screws in in the augmented screw group (17 versus 9; p

Introduction: Proximal peri-implant femoral fractures occur following intramedullary nailing (IMN) fixation for trochanteric, femoral shaft, and distal femoral fractures. However, analyses of secondary hip fractures (SHFs) using large clinical samples are lacking. Therefore, we aimed to report the incidence and clinical outcomes of SHF after nailing fixation (IMN or cephalomedullary nailing [CMN]) for overall femoral fractures. In addition, we focused on IMN for femoral shaft fractures and investigated the risk factors for SHF.Methods: This multicenter, retrospective, cohort study included 2,293 patients aged > 60 years who underwent nailing fixation for femoral fractures. The primary outcome was the incidence of SHF. In the assessment of clinical outcomes, we evaluated reoperation and the regaining of walking ability following SHF management. In addition, we conducted multivariable logistic regression analyses to examine the association between risk factors and SHF.Results: Seventeen (0.7%) patients had SHFs, including 12 femoral neck fractures and 5 trochanteric fractures. Antegrade IMN was the most common type of nailing fixation. Multivariable analysis demonstrated that the absence of femoral head fixation was significantly associated with the incidence of SHF following IMN for femoral shaft fractures (odds ratio, 17.0; 95% confidence interval, 1.9-2265.7; p=0.006). In the assessment of clinical outcomes, there were two reoperations (16.7%) in the secondary femoral neck fracture group. Patients with secondary trochanteric fractures tended to have a lower probability of regaining walking ability than those with secondary femoral neck fractures (20% vs. 50%).Conclusions: In this multicenter study, the incidence of SHF after nail fixation for femoral fractures was 0.7%. The absence of femoral head fixation was significantly associated with SHF, and the clinical outcomes were poor. Therefore, femoral head fixation at the initial IMN fixation for femoral fractures may be a fixation option for surgeons to consider as an SHF prevention measure. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated the radiologic and clinical outcomes of a lateral incision single plate with and a single-incision double plating in elderly patients with osteoporotic distal femoral fractures. Materials and methods: We performed a retrospective study of 82 cases of distal femoral fractures from May 2004 to June 2018. Group A consisted of 42 patients who underwent single-plate fixation. Group B consisted of 40 patients who underwent double-plate fixation. The mean patient age was 77 years (67–87 years) and 76 years (64–86 years) in groups A and B, respectively. All patients were evaluated for procedure duration, time to union, range of knee motion, Lysholm knee score, and presence of complications. Results: The average procedure time was 81 min (66–92 min) and 110 min (95–120 min) in groups A and B, respectively (p = 0.33). One case in group B required bone grafting after 5 months. The average time to union was 14 weeks (9–19 weeks) and 12.2 weeks (8–19 weeks) (p = 0.63), and the mean range of knee motion was 105° (90–125°) and 110.7° (90°–130°) (p = 0.37) in groups A and B, respectively. There was no significant statistical difference between the two groups in the Lysholm knee score (p = 0.44) and knee society score (p = 0.53). Conclusion: The clinical and radiological outcomes were similar in the 2 groups. In elderly patients, double plate fixation for distal femoral fractures is an useful method for several advantages such as adequate exposure, easy manipulation, anatomical reduction and stable fixation. [ABSTRACT FROM AUTHOR]

INTRODUCTION Fractures of the distal femur are usually sustained from high velocity trauma in adults and trivial fall in elderly. These fractures are usually associated with severe degree of comminution and intra-articular involvement. Therefore, anatomical reduction of fracture fragments, restoration of limb length, and early mobilization are key factors for optimal outcomes of involved limb. This longitudinal study was intended to evaluate the functional outcome of distal femoral fracture in adults managed surgically by retrograde nail. MATERIAL AND METHODS This prospective and observational hospital based study was carried out in Orthopedics Department, Universal College of medical Sciences-Teaching Hospital (UCMS-TH) from July 2020 to June 2021. All patients with traumatic distal femoral fractures (AO/OTA type A) who fulfilled the inclusion criteria were enrolled in the study and were treated surgically by retrograde nail. Fracture was classified according to AO/OTA classification and functional outcome was assessed according to Neer's scoring system. Post-operatively patients were regularly followed at 6 weeks, 3 months and 6 months. RESULTS In this study of 30 cases, male to female ratio was 3:2 with mean age of 39.47 years. Road Traffic Accident (RTA) was most common mode of injury. The functional outcome evaluated according to Neer's scoring system was found good result in 43.3%, excellent in 36.7%, fair in 16.7% and poor in 3.3%. The mean Neer's score was 78.9. CONCLUSION Distal femoral fractures (AO/OTA type A) when treated with retrograde nailing has good to excellent functional outcome in majority of cases with minimal manageable complication. [ABSTRACT FROM AUTHOR]

Introduction Traditional lateral plate osteosynthesis for distal femoral fractures does not provide sufficient stabilization in comminuted fractures due to a lack of medial support. Materials and methods Study on 16 lower limbs of 9 cadavers was conducted. We performed osteosynthesis of distal femur with precontoured medial plate implantation using a minimally invasive surgical technique. Then, the soft tissues were dissected to explore an exact location of the medial plate and the distances between plate and crucial anatomic structures of the distal femur. Fifteen patients underwent surgical treatment of distal femoral fractures with a loss of medial stability (AO/OTA classification 33-A3, 33-C2, 33-C3 fracture types) using the method of low invasive double-plating. Follow-up examinations were performed after 6 to 12 months. Results were evaluated using KSS and Lysholm scales. Results Cadaver study showed safety and feasibility of described minimally invasive osteosynthesis of distal femoral fractures method. We did not encounter specific complications associated with medial plate implantation during surgery. All fractures healed 12 months after surgery. The functional outcomes were good and excellent in more than 70 % of cases according to KSS and Lysholm scales. Discussion Fracture management in the segments with eccentric axial load is still problematic. The double-plating technique is a promising method which can be used by trauma surgeons in distal femoral fractures without medial stability. However, further clinical research to prove safety and feasibility of this method of distal femoral fracture fixation in comparison with alternate ostheosynthesis techniques is needed to determine more specific indications for its application.

Abstract Background One of the rare complications of primary total knee arthroplasty is intra-operative fracture. Intra-operative fracture during revision knee arthroplasty has been well-documented but there is limited literature on fractures occurring during primary knee arthroplasty. We conducted a systematic review of the literature to compare and contrast the various studies to clearly define the predisposing factors, incidence, and characteristics of the fracture itself and to arrive at a consensus on the management and prevention of intra-operative fractures during primary knee arthroplasty. Methods The PubMed/Medline, Cochrane, Scopus and Embase databases were searched using keywords “intra-operative fracture”, “distal femoral fracture”, “tibial fracture”, “patella fracture” and “primary total knee arthroplasty”. A total of 158 articles were retrieved and after further filtration and exclusion processing, 10 articles that evaluated intra-operative fractures in primary total knee arthroplasty were included for the review. Results The reported incidence of intra-operative fractures varied from 0.2% to 4.4%. A higher incidence in female patients with a male to female ratio of 0.4 was reported. Posterior stabilized (PS) total knee arthroplasty was associated with higher risk of intra-operative femoral fractures by many authors in this review. Timing of occurrence and location of the intra-operative fractures can vary widely, with femoral fractures occurring more commonly during bone preparation, trialing and impaction of the final implant and tibial fractures occurring during preparation for the tibial keel and impaction of the tibial component. Conclusions Intra-operative fractures during primary total knee arthroplasty are rare with higher risk associated with osteoporosis, rheumatoid arthritis, advanced age, female gender, chronic steroid use, metabolic bone disorders, PS type of femoral implant and difficult surgical exposure of the knee joint due to severe deformities. A plethora of management options have been utilized according to surgeon preference. Standard principles of fracture fixation and arthroplasty principles should be followed to achieve stable internal fixation and any unstable fracture site should be bypassed with the utilization of stemmed components. Satisfactory radiographic and functional outcome can be expected with appropriate treatment.

Abstract Background To analyze the risk factors of revision operation after the treatment of distal femoral fracture with lateral locking plate (LLP). Methods Retrospective analysis of the clinical data of 152 cases with distal femoral fracture treated in our hospital from March 2005 to March 2019. The SPSS 26.0 software (univariate analysis and logistic regression analysis) was used to analyze the general condition, fracture-related factors, operation-related factors, and construct characteristics of internal fixation. Results Sixteen of 152 patients who were included in the study underwent revision surgery, with a revision rate 10.5%. Univariate analysis showed that there were significant differences in age, body mass index (BMI), fracture type, supracondylar involved or not, type of incision, quality of reduction, ratio of length of plate/fracture area (R1), the ratio of the length of the plate/fracture area above the condylar (R2), ratio of distance between proximal part of fracture and screw/working length of proximal plate (R3) between the two groups (P < 0.05). Logistic regression analysis showed that age [OR for age > 61.5 group is 4.900 (1.071–22.414)], fracture type [OR for A3 fracture is 8.572 (1.606–45.750), the OR for periprosthetic fracture after TKA is 9.073 (1.220–67.506)], poor reduction quality [OR is 7.663 (1.821–32.253)], and the ratio of the length of the plate/fracture area above the condylar were the possible risk factors (P < 0.05). Conclusion Age, fracture type (A3 and periprosthetic fracture after TKA), poor reduction quality, and the ratio of the length of the plate/fracture area above the condylar were the possible risk factors of the revision in distal femoral fractures treated with lateral locking plate. The appropriate application of the locking plate and operation strategy are the key to reduce the revision rate in distal femoral fractures.

Abstract Background Most patients suffering from distal femoral unicameral bone cysts (UBCs) are adolescents that require an early return to normal activities, including school attendance and sports exercises. However, the optimal choice of implants for such patients remains controversial. This study evaluated the application of pediatric physeal slide-traction plate (PPSP) in the treatment of pathological distal femoral fracture caused by UBCs. Methods Between Jan 2014 and Jan 2016, 11 (male = 6, female = 5) patients were reviewed retrospectively. Age, sex, operative time, limb-length discrepancy (LLD), and valgus angulation were all recorded for every patient. Results The average age of 11 patients was 12.2 ± 1.1 years. The operating time was 94.8 ± 7.8 min. The postoperative hospital stay was 5 to 7 days. The epiphyseal morphology in the operative leg was nearly normal. The plate was removed in an average of 19.5 ± 3.1 months. The knee range of motion (ROM) was normal in 9 patients, whereas 2 female patients reported a loss of less than 10 degrees of ROM as compared to the contralateral knee joint. Breakage of plates or refracture did not occur in our cases. All patients had a follow-up of at least 24 months. At the latest follow-up visit, all patients walked without a limp. None of the patients manifested obvious LLD and valgus deformity. Conclusion PPSP combined with curettage and bone grafting allows early mobilization and produces satisfactory outcomes for pathological fracture of distal femur secondary to UBCs in adolescents.

Abstract Background Implant anchorage in highly osteoporotic bone is challenging, since it often leads to osteosynthesis failure in geriatric patients with supracondylar femoral fractures. Cementation of screws is presumed to prevent such osteosynthesis failure. This study aimed to investigate the effect of a newly designed, cementable fenestrated condylar screw for plate fixation in a biomechanical setting. Methods Eight pairs of osteoporotic cadaver femora with an average age of 77 years, ranging between 62 and 88 years, were randomly assigned to either an augmented or a non-augmented group. In both groups an instable 33-A3 fracture according to the AO / OTA classification was fixed with an angular stable locking plate. All right samples received a cement augmentation of their fenestrated condylar screws with calcium phosphate bone cement (CPC). Mechanical testing was performed at a load to failure mode by cyclic axial loading, using a servohydraulic testing machine. Results With a mean of 2475 N (95% CI: 1727–3223 N), the pressure forces resulting in osteosynthesis failure were significantly higher in specimen with cemented condylar screws as compared to non-cemented samples (1875 N (95% CI: 1320–2430 N)) (p = 0.024). In both groups the deformation of the constructs, with the distal screws cutting through the condylar bone, were the most frequent cause for failure. Analysis of axial stiffness (p = 0.889) and irreversible deformity of the specimens revealed no differences between the both groups (p = 0.161). No cement leakage through the joint line or the medial cortex was observed. Conclusion Based on the present study results, the newly introduced, cementable condylar screw could be an encouraging feature for the fixation of supracondylar femoral fractures in patients with reduced bone quality in terms of load to failure accuracy of the cement application.

Resumen: La fractura femoral distal (FFD) compleja en el paciente anciano es infrecuente, pero su manejo es un desafío. En estos pacientes frágiles, la FFD se asocia a un elevado riesgo de complicaciones médicas y mortalidad. Su tratamiento óptimo sigue siendo controvertido. El objetivo del estudio es proponer nuestro tratamiento estándar, describir nuestros resultados y discutir su relevancia clínica. Reportamos 3 casos de pacientes ancianas y frágiles con múltiples comorbilidades que presentaron una FFD compleja a causa de un traumatismo de baja energía. Fueron tratadas con éxito mediante un reemplazo femoral distal. Las 3 pacientes presentaron una movilización precoz con carga completa (la media hasta la primera deambulación fue de 5 días), buenos resultados funcionales (la media de rango de movimiento de la rodilla fue de 103̊) y una estancia hospitalaria breve (media de 10 días). Según nuestra experiencia, la artroplastia primaria podría ser una buena elección terapéutica para las FFD complejas en los pacientes ancianos. Abstract: Complex distal femoral fracture (DFF) in the elderly patient is an infrequent but challenging scenario. In these fragile patients, DFF is associated with a high rate of medical complications and mortality. The optimum treatment remains controversial. Our aim is to propose our standard treatment, describe our results and discuss its clinical relevance. We describe 3 cases of elderly and fragile patients with multiple comorbidities who suffered a complex DFF after low energy trauma. They were successfully treated through a primary arthroplasty with distal femoral replacement. All the 3 patients presented early full weight-bearing mobilization (average time to first ambulation was 5 days), good functional outcome (mean knee range of motion was 103°) and short hospital length of stay (mean of 10 days). According to our experience, primary arthroplasty with distal femoral replacement could be a good therapeutic option for complex DFF in elderly patients.

Introduction: Retrograde femoral nailing is a frequently performed surgical procedure used to stabilize a supracondylar femur fracture. We are reporting a unique case where the insertion of the anteroposterior interlocking screw of a retrograde nail caused vascular damage. Within the elderly patient population, we anticipate the presence of significant collateral blood vessels, which increases the potential for vascular damage during the insertion of a proximal screw. In this instance, there was bleeding caused by a vascular injury after the insertion of proximal interlocking screws, which necessitated further examination and vascular embolization on the following day. The complexity above necessitates that the author makes adjustments to surgical techniques when inserting proximal screws of a retrograde nail in similar cases., Case Report: An 82-year-old female patient presented with a right periprosthetic supracondylar femur fracture. The fracture was managed by retrograde nail femur. Vascular injury during proximal anteroposterior screw insertion results in post-operative bleeding and marked hemoglobin drop. The bleeding is managed by computed tomography emergent vascular embolization., Conclusion: Vascular injury, due to the insertion of a proximal screw, is a rare but potentially dangerous complication that needs a high degree of suspicion to pick up and manage this rare serious complication promptly., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Distal femoral fractures are commonly treated with osteosynthesis. However, in older patients with osteoarthritis of the knee, acute primary total knee arthroplasty (TKA) may be performed to treat these fractures. Notably, no studies have documented the use of osteosynthesis in combination with distal femoral osteotomy (DFO) for treating distal femoral fractures in patients with knee osteoarthritis. This report presents the case of a 66-year-old woman with lateral compartment osteoarthritis accompanied by severe valgus knee deformity who underwent osteosynthesis for a distal femoral fracture combined with medial closing-wedge distal femoral osteotomy (MCWDFO) to correct the knee valgus deformity. She experienced a distal femoral fracture (AO/OTA 33B1.1) of the right knee because of a fall. Before the injury, she exhibited a limp due to severe knee pain with some limitations in knee flexion. Non-weight-bearing radiographs of the entire lower extremity suggested a percentage mechanical axis (%MA) of 115%, indicating severe valgus deformity. On day nine after the injury, we performed osteosynthesis for the distal femoral fracture and conducted an MCWDFO to correct the right knee valgus deformity. After MCWDFO, the %MA was corrected to 70%. Partial weight-bearing was initiated three weeks postoperatively and progressed to full weight-bearing at six weeks. To facilitate bone healing, low-intensity pulsed ultrasound (LIPUS) was applied for three months after surgery. Bone union was successfully achieved by month five. Some medial knee pain persisted for six months after surgery; nonetheless, the patient could walk without a limp. We considered that the integration of MCWDFO with osteosynthesis could provide a treatment option for patients with distal femoral fractures and lateral compartment osteoarthritis., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Fujita et al.)

OBJECTIVE: Currently, there is some controversy regarding the use of anterograde or retrograde intramedullary nails for extrararticular fractures of the distal femor. Therefore, this article systematically evaluated the difference in the efficacy and safety of anterograde and retrograde intramedullary nailing in the treatment of distal femoral extrararticular fractures. METHODS: The databases, including PubMed, Web of Science, The Cochrane Library, EMbase, Sciencedirect, Scopus, China National Knowledge Infrastructure, Chinese BioMedical Literature System, Wanfang Data, VIP database for Chinese Technical Periodicals, and Google Scholar were searched through Internet to collect clinical randomized controlled trials of antegrade and retrograde intramedullary nails for distal femoral fractures in adults at home and abroad. The basic data included in the study including the Harris score at the time of discharge, bone nonunion, fracture healing time, knee pain, operation time, intraoperative blood loss, and heterotopic ossification of the hip joints were extracted. The quality evaluation and analysis were conducted using Cochrane Handbook. The results of the included study were meta-analyzed by RevMan 5.3 software. RESULTS: Ten randomized controlled clinical trials were included, with a total of 757 fractures, including 370 cases in the retrograde intramedullary nail group and 387 cases in the antegrade intramedullary nail group. There were no statistically significant differences in operation time, intraoperative blood loss, fracture healing time, knee pain and heterotopic ossification of the hip joints between retrograde intramedullary nails and antegrade intramedullary nails (P > 0.05). At the time of discharge, the hip joints Harris score showed that the retrograde intramedullary nail group was superior to the antegrade intramedullary nail group (RR=1.22, 95% CI:1.04-1.45, P=0.02). The incidence of bone nonunion in retrograde intramedullary nail group was lower than that in antegrade intramedullary nail group (RR=0.37, 95% CI: 0.14-0.96, P=0.04). CONCLUSION: Evidence from 10 existing randomized controlled trials shows that retrograde intramedullary nails to repair the distal femoral shaft extraarticular fractures are superior to antegrade intramedullary nails in terms of hip function recovery and fracture healing. Therefore, retrograde intramedullary nails have certain advantages in the treatment of the distal femoral fractures. [ABSTRACT FROM AUTHOR]

Introduction: The goal of this study was to evaluate distal femoral minimally invasive plate osteosynthesis (MIPO) from a distal medial approach by use of a pre-bent helical implant.Material& Methods: A total of 18 lower extremities was evaluated. A 29.6 cm steel plate was constructed and pre-bent on bone specimens with a torsion of 55.7° A 5 cm incision was performed from the tip of the medial epicondyle alongside its centre in a proximal direction. The medial border of the vastus medialis was retracted anteriorly. The level of the proximal skin incision was determined using the length of the pre-bent plates. The proximal incision was performed at a length of 4 cm at the described height at a line between the lateral epicondyle and the tip of the greater trochanter. A raspatory was advanced beneath the vastus medialis in a proximal direction to create an extraperiosteal tunnel for plate insertion. The plate was fixed to the bone at its proximal and distal portion via screws. Following dissection, the distance between the nearest perforator to the proximal plate end was evaluated. The vertical distances between the medial border of the plate and the femoral artery and femoral nerve were measured at the level of the proximal plate end and at the level of the proximal margin of the vastoadductor membrane.Results: The most proximal perforating artery was located at a mean distance of 20.15 mm starting from the proximal plate margin. The mean interval between the medial border of the plate at the level of its proximal tip and the femoral artery was 51.9 mm. The average distance between the femoral nerve and the medial border of the proximal part of the plate was 42.3 mm. Regarding the interval between the medial border of the plate and the femoral artery, this was at a mean of 40.5 mm at the level of the proximal margin of the vastoadductor membrane. During dissection, none of the specimens showed any lesions of the adjacent anatomical characteristics.Conclusion: Our results indicate MIPO of the distal femur from a medial approach as a safe technique. [ABSTRACT FROM AUTHOR]

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Background and Purpose: New-onset deep vein thrombosis (DVT) reportedly affects prognosis and surgical outcomes of elderly patients. However, its effect on distal femur fractures (DFFs) remains unclear. We aimed to address the epidemiological characteristics and the associated predictors for post-operative DVT in patients with closed DFFs over age 60 years old.Patients and Methods: We designed a prospective cohort trial at our hospital between October 2018 and June 2020 and recruited consecutive 140 patients over age 60 years diagnosed with closed DFFs. We examined location and prognosis of postoperative DVT and then conducted a three month follow-up. We used Duplex ultrasonography (DUS) to diagnose DVT in all patients and then classified the subjects into DVT and non-DVT groups. We further classified DVTs into proximal, distal, and mixed thromboses and then performed Whitney U test or t test, receiver operating characteristic (ROC) curve analysis, Chi-square test, and multiple logistic regression analysis to confirm the adjusted factors of post-operative DVT.Results: We found a 35% (n = 49) overall incidence of post-operative DVTs, which occurred 5.7 days following open reduction internal fixation (ORIF). Among patients with post-operative DVTs, 53.1% (n = 26) and 10.2% (n = 5) were distal and proximal thromboses, respectively. Additionally, peroneal veins were the most common DVT sites (71.4%, n = 35). Multivariate analysis revealed that venous thrombosis at admission (odds ratio [OR], 4.619; 95% confidence interval [CI]: 2.072-10.299; P = 0.000), operation duration over 195 minutes (OR, 3.289; 95% CI, 1.155-9.370; P = 0.026), intra-operative blood loss over 325 mL (OR, 2.538; 95% CI, 1.047-6.155; P = 0.039) were the three independent risk factors of post-operative DVT. Unified antithrombotic agents after diagnosis showed that 16.3% (n = 8) of DVTs were completely recanalized, 12.6 days after first diagnosis.Conclusion: Our findings indicate a strong association between venous thrombosis at admission, the longer operation duration, and considerable intra-operative blood loss with high risk of post-operative DVTs in patients over age 60 years with closed DFFs. Preventive approaches for postoperative DVTs should seek to shorten operation duration and reduce intra-operative blood loss. [ABSTRACT FROM AUTHOR]