J Korean Orthop Assoc.  2011 Aug;46(4):326-334. 10.4055/jkoa.2011.46.4.326.

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

• Jang JH
• Jung GH
• Kim JD
• Kim CK

• KMID: 2185431
• DOI: http://doi.org/10.4055/jkoa.2011.46.4.326

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 123.6degrees. 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.

Keyword

distal femur; fracture; metaphyseal comminution; minimally invasive plate osteosynthesis (MIPO); axial malalignment

MeSH Terms

Extremities
Femur
Fractures, Open
Humans
Knee
Transplants

Figure

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  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.

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  Figure 2 Open wound was located on the anterolateral aspect of knee joint.

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  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.

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  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.

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  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.

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  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.

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