Dual plate fixation of distal femoral fractures

Abstract

Introduction: Distal femur fractures have high risk of delayed union and poor functional results. The traditional lateral locking plate fixation can lead to non-union. Biological and mechanical augmentation is needed in some cases. Objective: The aim of our study is to present our experience with double plate fixation, to clarify when it is necessary, which is the optimal plates configuration and the ideal surgical approach. Materials and methods: Twelve distal femoral fractures (AO types C2 and C3) stabilized with dual plates for a period of 6 years (2017-2023). Nine female patients, three male, average age 57 years. Eight high energy fractures (traffic accidents, falls from height), four low energy fractures. Two open fractures – Gustilio-Anderson type 2. One extensile anterolateral approach used in six cases. Six fractures treated through a combination of a lateral and a mini invasive medial approaches. Clinical and`functional recovery assessed according to the criteria of the Knee Society Clinical Rating System (KSCRS). Results: All fractures healed for a medium period of 4,5 months. Three of the functional results were graded as excellent, 6 as good, 2 as average and one as poor. The X-ray results were rated as excellent in nine fractures and good in three. There were 2 delayed healings. Distal medial screw loosening was reported in 5 cases. Flexion contracture was reported in four cases. Conclusion: The advantages of medial plate augmentation outweigh the risks and is indicated in certain complex distal femur fractures.