Open reduction and internal fixation of an open intra-articular distal femoral fracture with Synthes LCP distal femoral plate
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Distal femoral fractures account for around 6% of all fractures. They have a bimodal distribution, occuring in elderly patients following low energy injuries and in younger patients following high energy trauma such as road traffic accidents or falls from significant height. In older patients fractures around knee replacements (peri-prosthetic) or between ipsilateral hip and knee replacements (inter-prosthetic) are increasingly seen and implants specifically to deal with these challenging fractures have been developed.
Approximately half of all distal femoral fractures are intra-articular and this has a significant influence on the chosen approach to fixation and the method of fixation. The final outcome after a distal femoral fracture will depend on the severity of articular injury, disruption of the mechanical axis and the extent of the soft tissue injury with poorer outcomes occurring in those with inadequately restored joint surfaces, residual mechanical axis deviation or stiffness secondary to scarring around the knee or extensor mechanism resulting in knee stiffness. It should also be appreciated that these are not benign injuries and in the elderly mortality after these injuries is similar to that seen after hip fractures.
The majority of distal femur fractures will be surgically stabilised to restore joint anatomy and allow early mobilisation of both the knee joint and the patient. There are a number of fixation options, these include intra-medullary nailing with a retrograde technique, lateral plate with a condylar screw or blade plate, lateral plating with a locking plate or a medial buttress plate. The choice of implant will depend on the fracture pattern and the planned approach to fracture.
The Synthes LCP distal femoral plate is a development of the LISS (Less Invasive Stabilisation System) range. It has multiple locking screw options in the distal segment allowing for fixed angle stabilisation around the joint, where screw purchase in bone may be less reliable. As long as the correct surgical steps are followed and attention is paid to the positioning of the plate during fixation coronal and sagittal alignment can be reliably restored. The plates come in a variety of lengths and for proximal screws there are now locking and non-locking screw options, giving the surgeon adequate flexibility when planning fixation.
Author:Mr Paul Fenton FRCS (Tr & Orth).
Institution: The Queen Elizabeth hospital, Birmingham, UK.