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Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 10/2022

07-06-2021 | Trauma Surgery

Biomechanical and anatomical considerations for dual plating of distal femur fractures: a systematic literature review

Authors: Graham J. DeKeyser, Anne J. Hakim, Dillon C. O’Neill, Carsten W. Schlickewei, Lucas S. Marchand, Justin M. Haller

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2022

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Introduction

Distal femur fractures are challenging injuries historically associated with high rates of nonunion and varus collapse with operative management. As a result, clinical and research interest in dual plating (DP) of distal femur fractures has seen a dramatic increase in recent years. The purpose of this study was to systematically review the literature regarding vascular anatomy and biomechanics of distal femur fractures treated with DP constructs.

Materials and methods

A systematic literature review of two medical databases (PubMed & Scopus) was performed to identify peer-reviewed studies on the anatomy and biomechanics regarding DP of distal femur fractures. A total of 1,001 papers were evaluated and 14 papers met inclusion criteria (6 anatomy and 8 biomechanics). Methodological quality scores were used to assess quality and potential bias in the included studies.

Results

In the biomechanical studies, DP constructs demonstrated greater axial and rotational stiffness, as well as less displacement and fewer incidences of failure compared to all other constructs. Vascular studies showed that the femoral artery crosses the mid-shaft femur approximately 16.0–18.8 cm proximal to the adductor tubercle and it is located on average 16.6–31.1 mm from the femoral shaft at this location, suggesting that medial plate application can be achieved safely in the distal femur. The methodological quality of the included studies was good for biomechanical studies (Traa score 79.1; range 53–92.5) and excellent for anatomical studies (QUACs score 81.9; range 69.0–88.5).

Conclusions

Existing biomechanics literature suggests that DP constructs are mechanically stronger than other constructs commonly used in the treatment of distal femur fractures. Furthermore, medial distal femoral anatomy allows for safe application of DP constructs, even in a minimally invasive fashion. Dual plating should be considered for patients with distal femur fractures that have risk factors for instability, varus collapse, or nonunion.
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Literature
1.
Elsoe R, Ceccotti AA, Larsen P (2018) Population-based epidemiology and incidence of distal femur fractures. Int Orthop 42(1):191–196PubMedCrossRef
2.
Neer CS, 2nd, Grantham SA, Shelton ML (1967) Supracondylar fracture of the adult femur. A study of one hundred and ten cases. J Bone Joint Surg Am. 49(4):591–613
3.
Giles JB, DeLee JC, Heckman JD, Keever JE (1982) Supracondylar-intercondylar fractures of the femur treated with a supracondylar plate and lag screw. J Bone Joint Surg Am 64(6):864–870PubMedCrossRef
4.
Merchan EC, Maestu PR, Blanco RP (1992) Blade-plating of closed displaced supracondylar fractures of the distal femur with the AO system. J Trauma 32(2):174–178PubMedCrossRef
5.
Siliski JM, Mahring M, Hofer HP (1989) Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am, 71(1):95–104
6.
Hoskins W, Sheehy R, Edwards ER et al (2016) Nails or plates for fracture of the distal femur? data from the Victoria Orthopaedic Trauma Outcomes Registry. Bone Joint J 98(6):846–850PubMedCrossRef
7.
Lee JH, Park KC, Lim SJ, Kwon KB, Kim JW (2020) Surgical outcomes of simple distal femur fractures in elderly patients treated with the minimally invasive plate osteosynthesis technique: can percutaneous cerclage wiring reduce the fracture healing time? Arch Orthop Trauma Surg 140(10):1403–1412PubMedCrossRef
8.
Markmiller M, Konrad G, Südkamp N (2004) Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? Clin Orthop Relat Res 426:252–257CrossRef
9.
Schütz M, Müller M, Krettek C et al (2001) Minimally invasive fracture stabilization of distal femoral fractures with the LISS: a prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. Injury 32(3):48–54CrossRef
10.
von Keudell A, Shoji K, Nasr M, Lucas R, Dolan R, Weaver MJ (2016) Treatment options for distal femur fractures. J Orthop Trauma 30(Suppl 2):S25-27CrossRef
11.
Quinzi DA, Ramirez G, Kaplan NB, Myers TG, Thirukumaran CP, Ricciardi BF (2021) Early complications and reoperation rates are similar amongst open reduction internal fixation, intramedullary nail, and distal femoral replacement for periprosthetic distal femur fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg
12.
Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL (2011) Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma 25(Suppl 1):S8-14PubMedCrossRef
13.
Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ (2014) Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 28(2):83–89PubMedCrossRef
14.
Tank JC, Schneider PS, Davis E et al (2016) Early mechanical failures of the synthes variable angle locking distal femur plate. J Orthop Trauma 30(1):e7–e11PubMedCrossRef
15.
Yoon BH, Park IK, Kim Y, Oh HK, Choo SK, Sung YB (2021) Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta-analysis. Arch Orthop Trauma Surg 141(2):225–233PubMedCrossRef
16.
Myers P, Laboe P, Johnson KJ et al (2018) Patient Mortality in Geriatric Distal Femur Fractures. J Orthop Trauma 32(3):111–115PubMedCrossRef
17.
Smith JR, Halliday R, Aquilina AL et al (2015) Distal femoral fractures: The need to review the standard of care. Injury 46(6):1084–1088PubMedCrossRef
18.
Streubel PN, Ricci WM, Wong A, Gardner MJ (2011) Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res 469(4):1188–1196PubMedCrossRef
19.
Heiden JJ, Goodin SR, Mormino MA et al (2021) Early ambulation after hip fracture surgery is associated with decreased 30-day mortality. J Am Acad Orthop Surg 29(5):e238–e242PubMedCrossRef
20.
Lieder CM, Gaski GE, Virkus WW, Kempton LB (2021) Is immediate weight-bearing safe after single implant fixation of elderly distal femur fractures? J Orthop Trauma 35(1):49–55PubMedCrossRef
21.
Liporace FA, Yoon RS (2019) Nail plate combination technique for native and periprosthetic distal femur fractures. J Orthop Trauma 33(2):e64–e68PubMedCrossRef
22.
Lodde MF, Raschke MJ, Stolberg-Stolberg J, Everding J, Rosslenbroich S, Katthagen JC (2021) Union rates and functional outcome of double plating of the femur: systematic review of the literature. Arch Orthop Trauma Surg
23.
Park KH, Oh CW, Park KC et al (2021) Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg 141(2):207–214PubMedCrossRef
24.
Steinberg EL, Elis J, Steinberg Y, Salai M, Ben-Tov T (2017) A double-plating approach to distal femur fracture: A clinical study. Injury 48(10):2260–2265PubMedCrossRef
25.
Ruoff AC 3rd, Biddulph EC (1972) Dual plating of selected femoral fractures. J Trauma 12(3):233–241PubMedCrossRef
26.
Gehweiler D, Styger U, Gueorguiev B, Colcuc C, Vordemvenne T, Wähnert D (2021) Local bone quality measure and construct failure prediction: a biomechanical study on distal femur fractures. Arch Orthop Trauma Surg
27.
Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:71CrossRef
28.
Bates M (1989) The design of browsing and berrypicking techniques for the online search interface. Online Rev 13(5):407–424CrossRef
29.
Wilke J, Krause F, Niederer D et al (2015) Appraising the methodological quality of cadaveric studies: validation of the QUACS scale. J Anat 226(5):440–446PubMedPubMedCentralCrossRef
30.
Traa WA, Oomen PJ, den Hamer A, Heusinkveld MH, Maffulli N (2013) Biomechanical studies on transverse olecranon and patellar fractures: a systematic review with the development of a new scoring method. Br Med Bull 108:131–157PubMedCrossRef
31.
Jazrawi LM, Kummer FJ, Simon JA et al (2000) New technique for treatment of unstable distal femur fractures by locked double-plating: case report and biomechanical evaluation. J Trauma 48(1):87–92PubMedCrossRef
32.
Fontenot PB, Diaz M, Stoops K, Barrick B, Santoni B, Mir H (2019) Supplementation of lateral locked plating for distal femur fractures: a biomechanical study. J Orthop Trauma 33(12):642–648PubMedCrossRef
33.
Muizelaar A, Winemaker MJ, Quenneville CE, Wohl GR (2015) Preliminary testing of a novel bilateral plating technique for treating periprosthetic fractures of the distal femur. Clin Biomech (Bristol, Avon) 30(9):921–926CrossRef
34.
Park KH, Oh CW, Park IH, Kim JW, Lee JH, Kim HJ (2019) Additional fixation of medial plate over the unstable lateral locked plating of distal femur fractures: A biomechanical study. Injury 50(10):1593–1598PubMedCrossRef
35.
Todorov D, Zderic I, Richards RG et al (2018) Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures? J Orthop Res 36(10):2604–2611PubMedCrossRef
36.
Wright DJ, DeSanto DJ, McGarry MH, Lee TQ, Scolaro JA (2020) Supplemental fixation of supracondylar distal femur fractures: A biomechanical comparison of dual-plate and plate-nail constructs. J Orthop Trauma 34(8):434–440PubMedCrossRef
37.
Zhang J, Wei Y, Yin W, Shen Y, Cao S (2018) Biomechanical and clinical comparison of single lateral plate and double plating of comminuted supracondylar femoral fractures. Acta Orthop Belg 84(2):141–148PubMed
38.
Zhang W, Li J, Zhang H et al (2018) Biomechanical assessment of single LISS versus double-plate osteosynthesis in the AO type 33–C2 fractures: A finite element analysis. Injury 49(12):2142–2146PubMedCrossRef
39.
Jiamton C, Apivatthakakul T (2015) The safety and feasibility of minimally invasive plate osteosynthesis (MIPO) on the medial side of the femur: A cadaveric injection study. Injury 46(11):2170–2176PubMedCrossRef
40.
Kim JJ, Oh HK, Bae JY, Kim JW (2014) Radiological assessment of the safe zone for medial minimally invasive plate osteosynthesis in the distal femur with computed tomography angiography. Injury 45(12):1964–1969PubMedCrossRef
41.
Maslow JI, Collinge CA (2019) Course of the femoral artery in the mid- and distal thigh and implications for medial approaches to the distal femur: A CT Angiography Study. J Am Acad Orthop Surg 27(14):e659–e663PubMedCrossRef
42.
Sirisreetreerux N, Shafiq B, Osgood GM, Hasenboehler EA (2016) Medial knee approach: an anatomical study of minimally invasive plate osteosynthesis in medial femoral condylar fracture. J Orthop Trauma 30(11):e357–e361PubMedCrossRef
43.
Rollick NC, Gadinsky NE, Klinger CE et al (2020) The effects of dual plating on the vascularity of the distal femur. Bone Joint J 102(4):530–538PubMedCrossRef
44.
Kochish AI, Belen’kii IG, Sergeev GD, Maiorov BA (2020) Anatomical and clinical justification of a minimally invasive technique for implantation an additional medial plate for bone osteosynthesis in patients with fractures of the distal femur. Genij Ortopedii 26(3):306–312CrossRef
45.
McDonald TC, Lambert JJ, Hulick RM et al (2019) Treatment of distal femur fractures with the DePuy-synthes variable angle locking compression plate. J Orthop Trauma 33(9):432–437PubMedCrossRef
46.
Kubiak EN, Beebe MJ, North K, Hitchcock R, Potter MQ (2013) Early weight bearing after lower extremity fractures in adults. J Am Acad Orthop Surg 21(12):727–738PubMedCrossRef
Metadata
Title
Biomechanical and anatomical considerations for dual plating of distal femur fractures: a systematic literature review
Authors
Graham J. DeKeyser
Anne J. Hakim
Dillon C. O’Neill
Carsten W. Schlickewei
Lucas S. Marchand
Justin M. Haller
Publication date
07-06-2021
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-021-03988-9

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