Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution

Jae-Ho Jang; Gu-Hee Jung; Jae-Do Kim; Cheung-Kue Kim

doi:10.4055/jkoa.2011.46.4.326

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Jang, Jung, Kim, and Kim: Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2011; 46(4): 326-334.

Published online: 31 August 2011

DOI: https://doi.org/10.4055/jkoa.2011.46.4.326

Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution

Jae-Ho Jang, M.D., Gu-Hee Jung, M.D., Jae-Do Kim, M.D., Cheung-Kue Kim, M.D.

Department of Orthopedic Surgery, Gospel Hospital, Kosin University, Busan, Korea.

Correspondence to: Gu-Hee Jung, M.D. Department of Orthopaedic Surgery, Gospel Hospital, Kosin University, 34, Amnam-dong, Seo-gu, Busan 602-030, Korea. TEL: +82-51-990-6229, FAX: +82-51-243-0181, jyujin2001@kosin.ac.kr

Received 17 September 2010 Accepted 23 May 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We wanted to report on the functional results and the presence of axial malalignment after performing minimally invasive plate osteosynthesis in distal femur fractures with metaphyseal comminution.

Materials and Methods

Between March 2007 and June 2009, fifteen patients with distal femur fractures and metaphyseal comminution were treated with minimally invasive plate osteosynthesis, and they were followed for a mean of 17.0 months (range: 12-40 months). The fractures according to the AO/OTA classification were two cases of 33A and thirteen cases of 33C, and seven cases were open fracture. We analyzed the axial malalignment and functional results according to bone union and Sanders' score.

Results

All the fractures were united without a bone graft after a mean of 20.4 weeks (range: 16-26 weeks) after the definitive plate fixation. One case had superficial infection and a stiff knee. The average ROM of the knee was 123.6°. The average Sanders' score was 33.0, and the results were five cases of excellent results, eight cases of good results and two cases of fair results. There was axial malalignment such as varus malunion in 3 cases and valgus malunion in 2 cases and the average shortening of the limb length was 7.9 mm (range: 0.3-21.9 mm).

Conclusion

Minimally invasive plate osteosynthesis in a distal femur fracture with metaphyseal comminution provides satisfactory outcomes. However, this should be approached with caution because of the possibility of axial malalignment.

Keywords: distal femur, fracture, metaphyseal comminution, minimally invasive plate osteosynthesis (MIPO), axial malalignment

Figures and Tables

Figure 1

(A) The radiographs show intra-articular fracture of distal femur and fracture of proximal tibia. (B) A femoral angiogram demonstrates a complete block at the level of distal femur.

Figure 2

Open wound was located on the anterolateral aspect of knee joint.

Figure 3

(A) The radiograph shows intra-articular fracture of the distal femur with metaphyseal comminution. (B) The CT scans show the fracture of posterior condyle. (C) The preliminary stabilization is achieved with spanning external fixator.

Figure 4

(A) The articular surface is exposed by parapatellar incision and repaired with 3.5 mm screws. (B) The plate is slid through submuscular space and fracture is reduced using the various instruments. (C) The photograph shows the preservation of soft tissue around fracture site. (D) The functional reduction is achieved by indirect reduction technique.

Figure 5

(A) The initial radiograph of a 36-year-old man shows distal femoral fracture with metaphyseal comminution. (B) The fracture site is not opened with a minimally invasive technique and fixed with LCP-DF® (synthesis, Switzerland). (C) Follow-up radiographs after 18 months show complete union of fracture. (D) The weight bearing line is shifted laterally from 29.2% to 38.5%. (E) However, the patient had an excellent knee function.

Figure 6

(A) For 6 screw fixation, at least 33mm of plate in length is required. (B) The most proximal hole for distal femurs is located on the 43mm from the distal end of plate.

Table 1

Summary of Cases

^*Gustilo-Anderson open fracture grading system; ^†Sander's functional score (E, excellent; G, good; F, fair; P, poor); ^‡Traffic accident; ^§Fall down; ^∥Industrial trauma; ROM, range of motion.

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