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Archives of Orthopaedic and Trauma Surgery

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Open Access 01-06-2022 | Femoral Fracture | Trauma Surgery

Union rates and functional outcome of double plating of the femur: systematic review of the literature

Authors: M. F. Lodde, M. J. Raschke, J. Stolberg-Stolberg, J. Everding, S. Rosslenbroich, J. C. Katthagen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 6/2022

Abstract

Background

The optimal treatment strategy for the surgical management of femur fractures and non-unions remains unknown. The aim of this study is to assess union rates, complications and outcome after femoral double plating. Treatment of shaft, distal, periprosthetic fractures and pathological proximal femur fractures as well as femoral non-unions with double plating were evaluated.

Methods

A systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement was conducted. Published literature reporting on the treatment and clinical outcome of femoral fractures and non-unions with double plating was identified. In total, 24 studies with 436 cases of double plating, 64 cases of single plating, 84 cases of intramedullary nailing (IM), and 1 interfragmentary screw treatment met the inclusion criteria of this systematic review. The evaluated literature was published between 1991 and 2020.

Results

Double plating of femoral fractures achieved high healing rates and few complications were reported. It displayed significantly less intraoperative haemorrhage, shorter surgery time reduced risk of malunion in polytraumatised patients when compared to IM. Fracture healing rate of double-plating distal femoral fractures was 88.0%. However, there were no significant differences regarding fracture healing, complication or functional outcome when compared to single plating. Treatment of periprosthetic fractures with double plating displayed high healing rates (88.5%). Double plating of non-unions achieved excellent osseous union rates (98.5%).

Conclusions

The literature provides evidence for superior outcomes when using double plating in distal femoral fractures, periprosthetic fractures and femoral non-unions. Some evidence suggests that the use of double plating of femoral fractures in polytraumatised patients may be beneficial over other types of fracture fixation.

Level of evidence

IV.

Katthagen JC, Schliemann B, Michel PA, Heilmann LF, Dyrna F, Raschke MJ (2020) Clinical application and outcomes of upper extremity double plating. Zeitschrift fur Orthopadie und Unfallchirurgie 158:227–237PubMedCrossRef

Sanders R, Swiontkowski M, Rosen H, Helfet D (1991) Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Jt Surg Am Vol 73:341–346CrossRef

Müller FJ, Galler M, Füchtmeier B (2014) Clinical and radiological results of patients treated with orthogonal double plating for periprosthetic femoral fractures. Int Orthop 38:2469–2472PubMedCrossRef

Maimaitiyiming A, Amat A, Rehei A, Tusongjiang M, Li C (2015) Treatment of the femoral shaft nonunion with double plate fixation and bone grafting: a case series of 14 patients. Injury 46:1102–1107PubMedCrossRef

Winquist RA, Hansen ST, Clawson DK (1984) Closed intramedullary nailing of femoral fractures. A report of five hundred and twenty cases. J Bone Jt Surg Am Vol 66:529–539CrossRef

Loomer RL, Meek R, de Sommer F (1980) Plating of femoral shaft fractures: the vancouver experience. J Trauma 20:1038–1042PubMedCrossRef

Apivatthakakul T, Chiewcharntanakit S (2009) Minimally invasive plate osteosynthesis (MIPO) in the treatment of the femoral shaft fracture where intramedullary nailing is not indicated. Int Orthop 33:1119–1126PubMedCrossRef

Cheng T, Xia R, Yan X, Luo C (2018) Double-plating fixation of comminuted femoral shaft fractures with concomitant thoracic trauma. J Int Med Res 46:440–447PubMedCrossRef

Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697PubMedCrossRef

10.

Gwathmey FW, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q (2010) Distal femoral fractures: current concepts. J Am Acad Orthop Surg 18:597–607PubMedCrossRef

11.

Ehlinger M, Ducrot G, Adam P, Bonnomet F (2013) Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res OTSR 99:353–360PubMedCrossRef

12.

Yoon B-H, Park IK, Kim Y, Oh H-K, Choo SK, Sung Y-B (2020) Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta-analysis. Arch Orthop Trauma Surg

13.

Meneghini RM, Keyes BJ, Reddy KK, Maar DC (2014) Modern retrograde intramedullary nails versus periarticular locked plates for supracondylar femur fractures after total knee arthroplasty. J Arthroplast 29:1478–1481CrossRef

14.

Tanaka T, Imanishi J, Charoenlap C, Choong PFM (2016) Intramedullary nailing has sufficient durability for metastatic femoral fractures. World J Surg Oncol 14:80PubMedPubMedCentralCrossRef

15.

Lane JM, Sculco TP, Zolan S (1980) Treatment of pathological fractures of the hip by endoprosthetic replacement. J Bone Jt Surg Am Vol 62:954–959CrossRef

16.

Kinkel S, Stecher J, Gotterbarm T, Bruckner T, Holz U (2009) Compound osteosynthesis for osteolyses and pathological fractures of the proximal femur. Orthopedics 32:403PubMed

17.

Friedl W (1992) Die Doppelplattenverbundosteosynthese. Ein Verfahren zur primär belastungsstabilen Versorgung von Problemverletzungen des subtrochanteren bis suprakondylären Femurbereiches. Aktuelle Traumatologie 22:189–196PubMed

18.

Merckaert SR, Fontanellaz-Castiglione CD, Fornari ED, Tannast M (2020) Double-plate compound osteosynthesis for pathological fractures of the proximal femur: high survivorship and low complication rate. Arch Orthop Trauma Surg 140:1327–1338PubMedCrossRef

19.

Ganz R, Isler B, Mast J (1984) Internal fixation technique in pathological fractures of the extremities. Arch Orthop Trauma Surg 103:73–80PubMedCrossRef

20.

Friedl W, Ruf W, Mischkowsky T (1986) Die Doppelplattenverbundosteosynthese bei subtrochanteren pathologischen Frakturen. Eine klinische und experimentelle Untersuchung. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 57:713–718PubMed

21.

Schöttle H, Sauer HD, Jungbluth KH (1977) Stabilitätsmessungen bei Osteosynthesen am proximalen Femur. Archiv fur orthopadische und Unfall-Chirurgie 89:87–100PubMedCrossRef

22.

Rompe JD, Eysel P, Hopf C, Heine J (1994) Metastatic instability at the proximal end of the femur. Comparison of endoprosthetic replacement and plate osteosynthesis. Arch Orthop Trauma Surg 113:260–264PubMedCrossRef

23.

Zura R, Xiong Z, Einhorn T, Watson JT, Ostrum RF, Prayson MJ, Della Rocca GJ, Mehta S, McKinley T, Wang Z et al (2016) Epidemiology of fracture nonunion in 18 human bones. JAMA Surg 151:e162775PubMedCrossRef

24.

Holzman MA, Hanus BD, Munz JW, O’Connor DP, Brinker MR (2016) Addition of a medial locking plate to an in situ lateral locking plate results in healing of distal femoral nonunions. Clin Orthop Relat Res 474:1498–1505PubMedPubMedCentralCrossRef

25.

Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg (Lond, Engl) 8:336–341CrossRef

26.

Wright JG, Swiontkowski MF, Heckman JD (2003) Introducing levels of evidence to the journal. J Bone Jt Surg Am 85:1–3CrossRef

27.

Coleman BD, Khan KM, Maffulli N, Cook JL, Wark JD (2000) Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports 10:2–11PubMedCrossRef

28.

Cheng T, Xia R-G, Dong S-K, Yan X-Y, Luo C-F (2019) Interlocking intramedullary nailing versus locked dual-plating fixation for femoral shaft fractures in patients with multiple injuries: a retrospective comparative study. J Invest Surg Off J Acad Surg Res 32:245–254

29.

Bai Z, Gao S, Hu Z, Liang A (2018) Comparison of clinical efficacy of lateral and lateral and medial double-plating fixation of distal femoral fractures. Sci Rep 8:4863PubMedPubMedCentralCrossRef

30.

Imam MA, Torieh A, Matthana A (2018) Double plating of intra-articular multifragmentary C3-type distal femoral fractures through the anterior approach. Eur J Orthop Surg Traumatol Orthop Traumatol 28:121–130CrossRef

31.

Khalil AE-S, Ayoub MA (2012) Highly unstable complex C3-type distal femur fracture: can double plating via a modified Olerud extensile approach be a standby solution? J Orthop Traumatol Off J Italian Soc Orthop Traumatol 13:179–188CrossRef

32.

Ziran BH, Rohde RH, Wharton AR (2002) Lateral and anterior plating of intra-articular distal femoral fractures treated via an anterior approach. Int Orthop 26:370–373PubMedPubMedCentralCrossRef

33.

Metwaly RG, Zakaria ZM (2018) Single-incision double-plating approach in the management of isolated, closed osteoporotic distal femoral fractures. Geriatr Orthop Surg Rehabil 9:2151459318799856PubMedCrossRef

34.

Steinberg EL, Elis J, Steinberg Y, Salai M, Ben-Tov T (2017) A double-plating approach to distal femur fracture: a clinical study. Injury 48:2260–2265PubMedCrossRef

35.

Çiçek H, Tuhanioğlu Ü, Oğur HU, Seyfettinoğlu F, Bozkurt M (2018) An alternative treatment for osteoporotic Su Type III periprosthetic supracondylar femur fractures: double locking plate fixation. Acta orthopaedica et traumatologica turcica 52:92–96PubMedPubMedCentralCrossRef

36.

Park K-H, Oh C-W, Park K-C, Kim J-W, Oh J-K, Kyung H-S, Kim H-J, Yoon Y-C (2020) Excellent outcomes after double-locked plating in very low periprosthetic distal femoral fractures. Arch Orthop Trauma Surg

37.

Bologna MG, Claudio MG, Shields KJ, Katz C, Salopek T, Westrick ER (2020) Dual plate fixation results in improved union rates in comminuted distal femur fractures compared to single plate fixation. J Orthop 18:76–79PubMedCrossRef

38.

Su ET, DeWal H, Di Cesare PE (2004) Periprosthetic femoral fractures above total knee replacements. Am Acad Orthop Surg 12:12–20CrossRef

39.

Chapman MW, Finkemeier CG (1999) Treatment of supracondylar nonunions of the femur with plate fixation and bone graft. J Bone Jt Surg Am Vol 81:1217–1228CrossRef

40.

Laflamme GY, Leduc S, Petit Y (2012) Reattachment of complex femoral greater trochanteric nonunions with dual locking plates. J Arthroplast 27:638–642CrossRef

41.

Peng Y, Ji X, Zhang L, Tang P (2016) Double locking plate fixation for femoral shaft nonunion. Eur J Orthop Surg Traumatol Orthop Traumatol 26:501–507CrossRef

42.

Nagy MT, Pydisetty G, Kwaees TA, Saldanha K (2020) Outcome of revision surgery for bisphosphonate related subtrochanteric fracture non-union following failed intramedullary nailing. Injury

43.

Lu J, Guo S-C, Wang Q-Y, Sheng J-G, Tao S-C (2020) J-bone graft with double locking plate: a symphony of mechanics and biology for atrophic distal femoral non-union with bone defect. J Orthop Surg Res 15:144PubMedPubMedCentralCrossRef

44.

Mardani-Kivi M, Karimi Mobarakeh M, Keyhani S, Azari Z (2020) Double-plate fixation together with bridging bone grafting in nonunion of femoral supracondylar, subtrochanteric, and shaft fractures is an effective technique. Musculoskelet Surg 104:215–226PubMedCrossRef

45.

Sun L, Li Z, Ma T, Xue H-Z, Wang Q, Lu D-G, Lu Y, Ren C, Li M, Zhang K (2019) Treatment of atrophic nonunion via autogenous ilium grafting assisted by vertical fixation of double plates: a case series of patients. J Int Med Res 47:1998–2010PubMedPubMedCentralCrossRef

46.

Alonso J, Geissler W, Hughes JL (1989) External fixation of femoral fractures. Indications and limitations. Clin Orthop Relat Res 1989:83–88

47.

Geissler WB, Powell TE, Blickenstaff KR, Savoie FH (1995) Compression plating of acute femoral shaft fractures. Orthopedics 18:655–660PubMedCrossRef

48.

Rüedi TP, Lüscher JN (1979) Results after internal fixation of comminuted fractures of the femoral shaft with DC plates. Clin Orthop Relat Res 1979:74–76

49.

Riemer BL, Butterfield SL, Burke CJ, Mathews D (1992) Immediate plate fixation of highly comminuted femoral diaphyseal fractures in blunt polytrauma patients. Orthopedics 15:907–916PubMedCrossRef

50.

Ebraheim NA, Martin A, Sochacki KR, Liu J (2013) Nonunion of distal femoral fractures: a systematic review. Orthop Surg 5:46–50PubMedPubMedCentralCrossRef

51.

Chan DB, Jeffcoat DM, Lorich DG, Helfet DL (2010) Nonunions around the knee joint. Int Orthop 34:271–281PubMedCrossRef

52.

Moore TJ, Watson T, Green SA, Garland DE, Chandler RW (1987) Complications of surgically treated supracondylar fractures of the femur. J Trauma 27:402–406PubMedCrossRef

53.

Barrack RL, Butler RA (2005) Current status of trochanteric reattachment in complex total hip arthroplasty. Clin Orthop Relat Res 441:237–242PubMedCrossRef

54.

Takahira N, Itoman M, Uchiyama K, Takasaki S, Fukushima K (2010) Reattachment of the greater trochanter in total hip arthroplasty: the pin-sleeve system compared with the Dall-Miles cable grip system. Int Orthop 34:793–797PubMedPubMedCentralCrossRef

55.

Koyama K, Higuchi F, Kubo M, Okawa T, Inoue A (2001) Reattachment of the greater trochanter using the Dall-Miles cable grip system in revision hip arthroplasty. J Orthop Sci Off J Japn Orthop Assoc 6:22–27

56.

Ritter MA, Eizember LE, Keating EM, Faris PM (1991) Trochanteric fixation by cable grip in hip replacement. J Bone Jt Surg Br Vol 73:580–581CrossRef

57.

Hamadouche M, Zniber B, Dumaine V, Kerboull M, Courpied JP (2003) Reattachment of the ununited greater trochanter following total hip arthroplasty. The use of a trochanteric claw plate. J Bone Jt Surg Am Vol 85:1330–1337CrossRef

Title: Union rates and functional outcome of double plating of the femur: systematic review of the literature
Authors: M. F. Lodde
M. J. Raschke
J. Stolberg-Stolberg
J. Everding
S. Rosslenbroich
J. C. Katthagen
Publication date: 01-06-2022
Publisher: Springer Berlin Heidelberg
Keywords: Femoral Fracture
Periprosthetic Fracture
Fracture Healing
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 6/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03767-6

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Union rates and functional outcome of double plating of the femur: systematic review of the literature

Abstract

Background

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of evidence

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