Dual plating in the management of nonunion complex distal femur fractures following lateral locked plate fixation: radiological and functional outcomes of a prospective study.

Abstract

Purpose: Managing complex distal femur fractures presents technical challenges. Although the lateral locked plate has become standard for these fractures, failures are not uncommon when this device is used alone. Patients with nonunion of distal femur fractures following treatment with a single lateral locked plate were examined. Revision surgery was performed by applying dual plates, and their efficiency was evaluated.

Methods: This study investigated 24 aseptic and 3 septic nonunions of distal femur fractures, classified as AO/OTA type C, that were previously managed with open reduction and internal fixation using only a lateral locked plate. Revision surgery involved replacing the broken 5.0-mm lateral locked plate, supplementing the medial side with a 4.5-mm T-plate, and applying bone grafting at the fracture site. Septic cases were managed using a staged approach with dual implant application.

Results: Following revision surgery, bony union was achieved in 83.3% of aseptic nonunions, with a mean bone healing time of 22.5 weeks (range, 15-27 weeks). Additional surgery was required for the remaining 16.6%. Using staged management, the septic nonunions were united in a mean of 30.25 weeks (range, 27-32 weeks). Significant improvements were noted in the Tegner Lysholm Knee Scoring Scale, with median preoperative and postoperative scores of 30 (range, 12-67) and 80 (range, 66-90), respectively (P<0.001). Limb pain, as measured by the visual analog scale for knee pain, improved significantly from a preoperative median of 6 (range, 4-8) to 3 (range, 1-6) postoperatively (P<0.001). All patients were ambulatory without supportive devices. However, the mean knee range of motion was 80° (range, 40°-120°). Limb shortening was observed in six cases (22.2%; average shortening, 2.3±1.0 cm).

Conclusions: Dual plating appears to be an effective approach for managing failed complex distal femur fractures following initial treatment with a single lateral locked plate.