A prospective study of functional outcome in distal femoral fractures treated with locking compression plate by bridging plating method
Sandeep Bhinde, Vivek Singh, Pravesh Jain
Background and Objectives: Lower limb fractures are the most common injuries due to increased frequency of road traffic accidents in the world which is the major mode of trauma. With the better understanding of fracture healing, recent advances and development of newer fixation techniques shown promising results in the treatment of complex lower limb fractures. In our study we are using a unique plate fixation technique to treat the lower limb fractures called Biological plate fixation-Bridge plating. It uses the plate as an internal fixator to fix the two main fracture fragments. Length, alignment and rotation are restored without touching the complex fracture zone. Here fracture is healed by callus formation unlike conventional plating technique. Titanium Locking plates are the most commonly used implant worldwide as bridging plate. The modulus of elasticity for titanium is low and it is comparable to that of bone. This helps in achieving relative stability which is necessary for the fracture union in comminuted fractures. This relative stability is achieved by leaving not less than half of the screw holes empty. But in developing country like India all patients cannot afford the titanium plates. Hence, we studied the bridging plate concept using cost-effective stainless-steel Locking Compression Plate to evaluate the outcome. Material and Methods: We have studied 60 cases of distal femur fractures. All the cases were fixed using stainless steel locking compression plate by Bridging plate method. The study period was from July 2016 to Dec 2019. Observation and Results: In our study of the 60 patients treated, 22 (36%) patients had excellent outcome, 30(50%) had good results, 08 (14%) had fair outcome & no poor result (Graph -03) We had 14(23%) patients with the complications includes Superficial infection in 4(6%) patients, Joint stiffness in 6(10%) patients, Varus angulation knee of 100 in 2(3%) patient, deep infection in1(2%), screw loosening in 1 (2%). (Table-03). we followed up all the patients for a period ranging from 22 weeks to until the fracture unites. The average time for union of fractures was 20 weeks ranging from 16-28 weeks. (Graph -02) The average knee flexion at the final follow-up was 106 degrees.76% of patients (46 of 60) had a flexion of >= 110 degrees. In the majority of cases, the range of knee flexion was 100-110 degrees. (Table-01) Conclusion: we conclude that the stainless-steel locking compression plate system acts as a good biological fixation. Even though Stainless-steel plate has high modulus of elasticity, it is flexible enough to be used as bridge plate to achieve callus formation and fracture union in comminuted fractures of femur with a few acceptable complications which can be prevented by proper following of the principles of bridge plating.
Sandeep Bhinde, Vivek Singh, Pravesh Jain. A prospective study of functional outcome in distal femoral fractures treated with locking compression plate by bridging plating method. International Journal of Orthopaedics Research, Volume 2, Issue 1, 2020, Pages 15-19