Single-Incision Double-Plating Approach in the Management of Isolated, Closed Osteoporotic Distal Femoral Fractures

Abstract

Introduction: Distal femoral fractures in elderly population had recorded an increase in incidence in the last 2 decades. Lateral distal femoral locking plating is considered one of the best options especially when dealing with comminuted fractures but varus collapse of the medial femoral condyle occurs frequently in patients with osteoporosis. Anatomical reduction of the fracture with stable rigid fixation using double-plating approach allows early mobilization of geriatric population and prevents varus collapse minimizing the comorbidities in such fractures. Patients and Methods: Between September 2014 and January 2017, a prospective study on 23 patients with comminuted osteoporotic distal femoral fractures managed through the double-plating approach through a single parapatellar approach has been conducted. Only osteoporotic geriatric patients with isolated distal femoral fractures were included. Polytraumatized, open fractures, and fracture type 33-A1, 33-A2, and 33-B were excluded. The mean age was 69.6 years (61-80). All patients have been evaluated as regard duration of procedure, time to union, EQ-5D-5L score, the need of autologous bone grafts, range of knee motion, and presence of complications. Results: The average follow-up was 14.1 months. The majority of fractures were type 33-C2 (13 patients). Average procedure time was 148 minutes (117-193 minutes). Mean EQ-5D-5 L score was 83.8 (72-82). Average time to union was 9 months (3-12 months). Four (17.4%) cases needed autologous bone graft after 6 months. No loss of reduction in any of the cases was evident, although 6 (26%) cases had screw breakage or cutout in one of the plate fixation. Two (8.7%) patient developed superficial wound infection and 1 (4.3%) developed DVT. Discussion: This study aimed at evaluation of the success of double plating of distal femoral fractures in geriatric population. different fixation methods were studied for reduction and fixation of such a fracture such as external fixation, intramedullary nails and lateral plating. the quality of fracture reduction, functional and radiological outcomes, time to union, the need for bone grafting and complication are the main debatable issues. Conclusion: Single-incision double-plating approach for distal femoral osteoporotic fractures is effective and provides stable construct without reduction loss allowing early rehabilitation. Delayed union and the need for bone graft are the major drawbacks for this technique.