Comparative study of functional outcome in single plating and dual plating of unstable distal femur fractures

Abstract

Fractures of the distal femur remain challenging to treat as satisfactory outcome demands anatomical articular reduction, rigid and stable internal fixation along with early range of motion. The purpose of our study is to evaluate the functional outcome in patients with unstable fractures of the distal femur treated with single versus dual plating.: The study was a prospective study of 40 patients. The study was a prospective study of 40 patients (30 male and 10 female) with unstable fractures of the distal femur admitted to Goa medical college between June 2019 to June 2021 treated with open reduction and internal fixation of the distal femur with locked plates. After admission patients were subjected to routine pre operative evaluation and x-rays along with CT scan with 3 D reconstruction. During surgery, after lateral plating patients were subjected to varus stress test on table. If found to be positive, medial plate was applied. Medial plating was also advocated if medial cortex was found to be deficient due to severe communition or bone loss. Patients were followed up for an average of 10 months and knee function was evaluated evaluated using Sanders Functional Evaluation Knee Score. Out of the 40 patients treated with plating, 24 were treated with single lateral plate and 16 were treated with medial as well as lateral plate. Out of the 16 treated with dual plating, 2 were open fractures treated by staged procedure (lateral plating and subsequent medial plating with iliac crest bone graft via a separate medial incision after a period of 10 weeks following primary surgery). 3 of the patients treated with single lateral plate showed a varus collapse upon weight bearing 12 weeks post op. It was found that dual plating resulted in high union rates, early post op mobilisation due to more rigid fixation and less chances of varus collapse. However, overall when functional.