Locked Plating in Elderly Patients with Distal Femur Fracture: How to Avoid Complications?

Distal femur fractures in elderly patients with osteoporosis are complicated because poor bone quality makes screw purchase and fixation less secure, presenting many clinical challenges to the orthopedic surgeon. Minimally invasive locked plating using an angularly stable locking compression plate has become an integral tool for achieving secure fixation in osteoporotic distal femur fractures with improved biomechanical performance. On the other hand, complications, such as implant failure and periplate fracture, have still occurred. This paper describes the principles of internal fixation in minimally invasive lateral locked plating in elderly patients with osteoporotic distal femur fractures as well as how to avoid complications.

Proximal Humerus Nonunion: Operated with Fibular Strut Allograft and Locking Plate.

Proximal humerus fracture is one of the common fractures seen in practice. Being metaphyseal region, it is less prone for nonunion. Although more than 80% of these heal with no surgical intervention, displaced unimpacted surgical neck fractures are associated with a higher incidence of nonunion with rates varying from less than 1% to as high as 23%. We report a case of 35-year-old male with nonunion following fracture of left proximal humerus.

The Outcome and Complications of the Locked Plating Management for the Periprosthetic Distal Femur Fractures after a Total Knee Arthroplasty

BACKGROUND: The osteosynthesis of the periprosthetic fractures following a total knee arthroplasty (TKA) can be technically difficult with the relatively small satisfactory outcomes and the high complication rates. The purpose of the study is to analyze the mid-term radiological and functional outcomes following the locked plating of the distal femur periprosthetic fractures after a TKA. METHODS: Records of 20 patients with a periprosthetic distal femur fracture following TKA treated by the locked plate osteosynthesis were retrospectively evaluated. The union rate, complications and functional outcome measures were analyzed. RESULTS: Successful union was achieved in 18 of the 19 patients available for the follow-up. The mean follow-up was 39 +/- 10 months. Significant reductions (p < 0.05) in the range of motion and Western Ontario and McMaster Universities Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were evident in the follow-up. Secondary procedures were required in 5 patients to address the delay in union and the reduced knee range of motion. The osteosynthesis failed in 1 patient who underwent a revision TKA. CONCLUSIONS: The satisfactory union rates can be achieved with the locked plate osteosynthesis in the periprosthetic distal femur fractures after TKA. Prolonged rehabilitation coupled with the un-modifiable risk factors can decrease the activity and satisfaction levels, which can significantly alter the functional outcome.

Periprosthetic Fracture after Locked Plating in the Osteoporotic Long Bone Fracture / 대한정형외과학회잡지

The locking plate is used for osteoporotic long bone fracture because of the ability to affect a lock between the plate and locking screws that prevents reduction loss, angular deformity and axial deformity. However, it has been reported that locked plating can increase the periprosthetic fracture risk in osteoporotic bone compared with conventional plating. We report 3 cases of periprosthetic fracture after the use of locked plating in osteoporotic long bone fracture and a review of the relevant literatures.