The Management of Aseptic Non-unions of Distal Femur Fractures with Anatomical Lateral Locking Plates

JOURNAL TITLE: Strategies in Trauma and Limb Reconstruction

Author
1. John Mukhopadhaya
2. Rajeev Ranjan
3. Amit Kumar Sinha
4. Janki Sharan Bhadani
ISSN
1828-8936
DOI
10.5005/jp-journals-10080-1564
Volume
17
Issue
3
Publishing Year
2022
Pages
7
Author Affiliations
    1. Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India
    1. All India Institute of Medical Sciences, New Delhi, India
    2. All India Institute of Medical Sciences, Patna, Bihar, India
    3. All India Institute of Medical Sciences Bhubaneshwar, Odisha, India
    1. Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India
    1. Department of Orthopaedics, Paras HMRI Hospital, Patna, Bihar, India
  • Article keywords
    Aseptic non-union, Autologous bone grafting, Compression device, Decortication, Distal femur fracture, Distal femur locking plate, Lateral locking plate, Non-union

    Abstract

    Background: Distal femoral non-unions are challenging, and frequently associated with short distal fragments, poor bone stock, and with issues from previous implants. Materials and methods: A retrospective study of 31 patients admitted with distal femoral non-unions treated using anatomical lateral locking plates. Non-union scores were used. The Knee Society and Neer’s scores were used for the comparison of results. The mean follow-up was 39.5 months (from 24 months to 60 months). Results: Stable union was accomplished in all. There was a significant improvement in the average Neer’s score (24 preoperative to 82 post-operatively at final follow-up), the Part 1 Knee Society score from an average of 46 preoperatively to 84 post-operatively, and Part 2 Knee Society score from 36 preoperatively to 80 post-operatively. Conclusion: Optimal stability, good compression at the non-union site (either by lag screws or a compression device or both), maintaining the axial alignment strictly, freshening of bone ends, using an adequate amount of cortico-cancellous bone graft, respecting the biology along with the correct choice of the implant (including the size) are essential to achieve union at the fracture site. Clinical significance: Paying attention to the basic principles of management, good contact, stability and maintaining biology is essential in the treatment of non-union.

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