Dual plate fixation may be more effecting for periprosthetic distal femur fractures

1. In patients with distal femoral periprosthetic fractures (DFPF), patients treated with dual plating (DP) were more likely to be weight-bearing in the twelve-week postoperative period, compared with those treated with distal femoral locking plates (DFLP).

2. Compared with the DFLP group, the DP patients were more likely return to their baseline ambulatory status.

Evidence Rating Level: 3 (Average)

With an aging population and increasing rates of knee arthroplasty, the incidence of DFPF is expected to grow. Historically, treatments for distal femur fractures used large fragment plates, but complication rates were high due to inadequate angular stability and distal fixation. Recent trends favor dual implants, such as plate-nail or DP combinations. This is the largest comparative case series that aims to determine the efficacy of DP compared with single implant (DFLP) fixation of DFPF. Between 2015-2021 38 patients (mean age [SD], 75.9 [11.3] years; mean follow up,  19.8 [16.1] months; 81.5% female; mean BMI, 29.5 [6.3] kg/m2) with DFPF treated with DP and 34 patients (mean age [SD], 74.8 [7.3] years; mean follow up, 18.2 [13.8 months]; 81.5% female; mean BMI,  33.2 [7.7] kg/m2) treated with DFLP were identified and included in the analysis. There was a significant difference in fracture morphology based on the Su classification (P < 0.001), with a higher prevalence of Su type 1 fractures in the DFLP group and more type 3 fractures in the DP group. However, no significant difference in morphology was observed based on the OTA/AO classification (P = 0.273). There was no significant difference in reoperation rate, coronal alignment change, nonunion, malunion, infection, or hardware failure between groups. Significantly more DP patients were allowed to immediately weight bear compared with DFLP (87% vs. 9%, P < 0.001). The DP group achieved a return to baseline ambulation in 73% of cases, in contrast to 38% in the DFLP group (P = 0.004). In effect, this study suggests that compared with DFLP, DP of DFPF enables immediate weight-bearing with effective maintenance of coronal alignment, non-inferior reoperation rate, and a more reliable return to baseline ambulation.

Click to read the study in Journal of Orthopaedic Trauma

Image: PD

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