Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Distal Femoral Fractures

Abstract

Purpose.

To evaluate treatment outcomes of minimally invasive plate osteosynthesis (MIPO) for distal femoral fractures in 31 patients.

Methods.

22 male and 9 female consecutive patients aged 21 to 65 (mean, 42) years underwent minimally invasive plate osteosynthesis using a locking compression plate (LCP) for distal femoral fractures. The causes of injury were vehicular accidents (n=24), falls (n=6), and assault (n=1). According to the AO classification, the fractures were classified as types A1 (n=10), A2 (n=7), and A3 (n=14). Most fractures were closed; 3 were Gustilo type-II fractures. Clinical and functional outcomes were assessed using the Knee Society Scores.

Results.

The mean operating time was 70 (range, 60–100) minutes. The mean length of hospital stay was 9 (6–14) days. The mean time to union was 3.7 (range, 2.8–4.6) months. The mean follow-up period was 18 (14–26) months. At the one-year follow-up, 29 of the patients had good or excellent outcomes. No patient had angular or rotational deformity of >10°. One osteoporotic woman with a type-A1 fracture had implant failure at 10 weeks and underwent revision surgery. Another patient with a type-A1 fracture had persistent pain on the lateral aspect of the distal thigh and underwent implant removal at 22 months. No patient developed deep infection, malunion or nonunion.

Conclusion.

MIPO using a LCP achieves favourable biological fixation for distal femoral fractures with few complications. Bone grafting is not needed even in cases of metaphyseal comminution. Proper patient selection and preoperative planning are essential to prevent complications.

Keywords

bone plates femoral fractures fracture fixation,internal internal fixators

References

Higgins

. Distal femoral fractures. J Knee Surg 2007;20:56–66.

Schutz

Sudkamp

. Revolution in plate osteosynthesis: New internal fixator systems. J Orthop Sci 2003;8:252–8.

Egol

Kubiak

Fulkerson

Kummer

Koval

. Biomechanics of locked plates and screws. J Orthop Trauma 2004;18:488–93.

Stoffel

Dieter

Stachowiak

Gachter

Kuster

. Biomechanical testing of the LCP—how can stability in locked internal fixators be controlled? Injury 2003;34(Suppl 2):B11–9.

Wagner

Frenk

Frigg

. New concepts for bone fracture treatment and the Locking Compression Plate. Surg Technol Int 2004;12:271–7.

Wagner

. General principles for the clinical use of the LCP. Injury 2003;34(Suppl 2):B31–42.

Perren

. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: Choosing a new balance between stability and biology. J Bone Joint Surg Br 2002;84:1093–110.

Niemeyer

Sudkamp

. Principles and clinical application of the locking compression plate (LCP). Acta Chir Orthop Traumatol Cech 2006;73:221–8.

Frigg

. Locking Compression Plate (LCP). An osteosynthesis plate based on the Dynamic Compression Plate and the Point Contact Fixator (PC-Fix). Injury 2001;32(Suppl 2):63–6.

10.

Leunig

Hertel

Siebenrock

Ballmer

Mast

Ganz

. The evolution of indirect reduction techniques for the treatment of fractures. Clin Orthop Relat Res 2000;375:7–14.

11.

Deshmukh

Lou

Neo

Yew

Rozman

George

. A technique to obtain correct rotational alignment during closed locked intramedullary nailing of the femur. Injury 1998;29:207–10.

12.

Kregor

Stannard

Zlowodzki

Cole

. Treatment of distal femur fractures using the less invasive stabilization system: Surgical experience and early clinical results in 103 fractures. J Orthop Trauma 2004;18:509–20.

13.

Baumgaertel

Buhl

Rahn

. Fracture healing in biological plate osteosynthesis. Injury 1998;29(Suppl 3):C3–6.

14.

Insall

Dorr

Scott

. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res 1989;248:13–4.

15.

Hontzsch

. Distal femoral fracture—technical possibilities [in German]. Kongressbd Dtsch Ges Chir Kongr 2001;118:371–4.

16.

Schatzker

Tile

. The rationale of operative fracture care. Berlin: Springer Verlag; 1987.

17.

Klaue

. Principles of plate and screw osteosynthesis. In: Bulstrode

, Buckwalter

, Carr

, editors. Oxford textbook of orthopaedics and trauma. Oxford: Oxford University Press; 2002:1697–710.

18.

Frigg

Frenk

Haas

Regazzoni

. LCP The Locking Compression Plate system. In: Colton

, editor. AO Dialogue. Vol 14(1). Davos/Dubendorf: AO Publishing; 2001:16–7.

19.

Whittle

Wood

II . Fractures of the lower extremity. In: Canale

, editor. Campbell's operative orthopaedics. Vol 3, 3rd ed. Philadelphia: Mosby; 2003:2725–872.

20.

Greiwe

Archdeacon

. Locking plate technology: Current concepts. J Knee Surg 2007;20:50–5.

21.

Christodoulou

Terzidis

Ploumis

Metsovitis

Koukoulidis

Toptsis

. Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: A comparative study of the two methods. Arch Orthop Trauma Surg 2005;125:73–9.

22.

Hartin

Harris

Hazratwala

. Retrograde nailing versus fixed-angle blade plating for supracondylar femoral fractures: A randomized controlled trial. ANZ J Surg 2006;76:290–4.

23.

Kim

Kyung

Min

Yoon

. Factors affecting the results of distal femoral fractures treated by retrograde intramedullary nailing. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009;23:1311–5.

24.

Frigg

Appenzeller

Christensen

Frenk

Gilbert

Schavan

. The development of the distal femur Less Invasive Stabilization System (LISS). Injury 2001;32(Suppl 3):SC24–31.

25.

Schandelmaier

Partenheimer

Koenemann

Grun

Krettek

. Distal femoral fractures and LISS stabilization. Injury 2001;32(Suppl 3):SC55–63.

26.

Liu

. Treatment of distal femur fracture by less invasive stabilization system-distal femur [in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2007;21:1290–4.

27.

Kao

Hsu

Chou

. Treatment of distal femoral fracture by minimally invasive percutaneous plate osteosynthesis: Comparison between the dynamic condylar screw and the less invasive stabilization system. J Trauma 2009;67:719–26.

28.

Kolb

Guhlmann

Windisch

Marx

Kolb

Koller

. Fixation of distal femoral fractures with the Less Invasive Stabilization System: A minimally invasive treatment with locked fixed-angle screws. J Trauma 2008;65:1425–34.

29.

Kanabar

Kumar

Owen

Rushton

. Less invasive stabilisation system plating for distal femoral fractures. J Orthop Surg (Hong Kong) 2007;15:299–302.

30.

Sommer

Gautier

. Relevance and advantages of new angular stable screw-plate systems for diaphyseal fractures (locking compression plate versus intramedullary nail) [in German]. Ther Umsch 2003;60:751–6.

31.

Haidukewych

. Innovations in locking plate technology. J Am Acad Orthop Surg 2004;12:205–12.

32.

Ricci

Loftus

Cox

Borrelli

. Locked plates combined with a minimally invasive insertion technique for the treatment of periprosthetic supracondylar femur fractures above a total knee arthroplasty. J Orthop Trauma 2006;20:190–6.

33.

Fulkerson

Tejwani

Stuchin

Egol

. Management of periprosthetic femur fractures with a first generation locking plate. Injury 2007;38:965–72.

34.

Ehlinger

Cognet

Simon

. Treatment of femoral fracture on previous implants with minimally-invasive surgery and total weight-bearing: Benefit of locking plate. Preliminary report [In French]. Rev Chir Orthop Reparatrice Appar Mot 2008;94:26–36.

35.

Bahari

Lenehan

Khan

McElwain

. Minimally invasive percutaneous plate fixation of distal tibia fractures. Acta Orthop Belg 2007;73:635–40.

36.

Williams

Schenk

. Bridging-minimally invasive locking plate osteosynthesis (Bridging-MILPO): Technique description with prospective series of 20 tibial fractures. Injury 2008;39:1198–203.

37.

Shahid

Mushtaq

Sharma

Maqsood

. Distal tibial fracture fixation with locking compression plate (LCP) through minimally invasive percutaneous osteosynthesis (MIPO) technique. Injury Extra 2008;39:202.

38.

Hazarika

Chakravarthy

Cooper

. Minimally invasive locking plate osteosynthesis for fractures of the distal tibia—results in 20 patients. Injury 2006;37:877–87.

39.

Gonzalez

Hernanz Y

Martin

Diaz A

Sanchez

Jara F

Erasun

Resines C

. Early results with the new internal fixator systems LCP and LISS: A prospective study. Acta Orthop Belg 2007;73:60–9.

40.

Higgins

Pittman

Hines

Bachus

. Biomechanical analysis of distal femur fracture fixation: Fixed-angle screw-plate construct versus condylar blade plate. J Orthop Trauma 2007;21:43–6.

41.

Gautier

Sommer

. Guidelines for the clinical application of the LCP. Injury 2003;34(Suppl 2):B63–76.