Current status and progress of clinical research on distal femoral fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Jishizhan ,  LU Hua

Department of Orthopaedics, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, P.R.China;

Corresponding author：

LU Hua, Email: lhhawk@hotmail.com

Keywords：

Distal femoral fracture; internal fixation; external fixation; clinical research

DOI：

10.7507/1002-1892.201704132

Video：

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Objective To investigate current status and latest progress of clinical research on distal femoral fractures. Methods The related literature was extensively reviewed to summarize the trend of the researches and their clinical application in the treatment of distal femoral fractures. Results Distal femoral fractures are likely to occur in young people who suffer from high-energy damage and the elderly with osteoporosis, which is always comminuted and unstable fractures, and often involved in the articular surface and combined with serious soft tissue injury. Therefore, the treatment faces many challenges. External fixation is now used as a temporary means of controlling injury. The vast majority of patients are feasible to internal fixation, including plates system and intramedullary nail system. Different internal fixator also has its own characteristics, such as double plates can strengthen the medial support of the femur, less invasive stabilization system protects the blood supply of fractures, distal cortial locking plate is theoretically more fit for the requirements of bone healing, retrograde intramedullary nail can resist varus and valgus. Conclusion The treatment of distal femoral fractures should be based on the type of fracture and the characteristics of internal fixators.

Citation： CHEN Jishizhan, LU Hua. Current status and progress of clinical research on distal femoral fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(2): 242-247. doi: 10.7507/1002-1892.201704132 Copy

1.	Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, et al. Distal femoral fractures: current concepts. J Am Acad Orthop Surg, 2010, 18(10): 597-607.
2.	Link BC, Babst R. Current concepts in fractures of the distal femur. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 11-20.
3.	Pietu G, Lebaron M, Flecher X, et al. Epidemiology of distal femur fractures in France in 2011-12. Orthop Traumatol Surg Res, 2014, 100(5): 545-548.
4.	Kammerlander C, Riedmuller P, Gosch M, et al. Functional outcome and mortality in geriatric distal femoral fractures. Injury, 2012, 43(7): 1096-1101.
5.	Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma, 2012, 26(6): 327-332.
6.	Stewart MJ, Sisk TD, Wallace SL. Fractures of the distal third of the femur: a comparison of methods of treatment. J Bone and Joint Surg, 1966, 48(4): 784-807.
7.	Link BC, Babst R. Current concepts in fractures of the distal femur. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 11-20.
8.	Scalea TM, Boswell SA, Scott JD, et al. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma, 2000, 48(4): 613-623.
9.	Pape HC, Hildebrand F, Pertschy S, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma, 2002, 53(3): 452-462.
10.	Sala F, Capitani D, Castelli F, et al. Alternative fixation method for open femoral fractures from a damage control orthopaedics perspective. Injury, 2010, 41(2): 161-168.
11.	Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J Surg Orthop Adv, 2011, 20(1): 74-81.
12.	Parekh AA, Smith WR, Silva S, et al. Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation. Trauma, 2008, 64(3): 736-739.
13.	Ali F, Saleh M. Treatment of isolated complex distal femoral fractures by external fixation. Injury, 2000, 31(3): 139-146.
14.	El-Tantawy A, Atef A. Comminuted distal femur closed fractures: a new application of the Ilizarov concept of compression-distraction. Eur J Orthop Surg Traumatol, 2015, 25(3): 555-562.
15.	Cavusoglu AT, Ozsoy MH, Dincel VE, et al. The use of a low-profile Ilizarov external fixator in the treatment of complex fractures and non-unions of the distal femur. Acta Orthop Belg, 2009, 75(2): 209-218.
16.	Bedes L, Bonnevialle P, Ehlinger M, et al. External fixation of distal femoral fractures in adults' multicentre retrospective study of 43 patients. Orthop Traumatol Surg Res, 2014, 100(8): 867-872.
17.	Oh JK, Hwang JH, Sahu D, et al. Complication rate and pitfalls of temporary bridging external fixator in periarticular communited fractures. Clin Orthop Surg, 2011, 3(1): 62-68.
18.	Hutson JJ Jr, Zych GA. Treatment of comminuted intraarticular distal femur fractures with limited internal and external tensioned wire fixation. J Orthop Trauma, 2000, 14(6): 405-413.
19.	Hassankhani EG, Birjandinejad A, Kashani F, et al. Hybrid external fixation for open severe comminuted fractures of the distal femur. Surg Sci, 2013, 4(2): 176-183.
20.	张亚狮, 王建, 孙竞群. 股骨下端复杂骨折内固定方法的选择. 骨与关节损伤杂志, 2002, 17(4): 269-271.
21.	Nagy HM, Mehy EE, Issa KH. Butttress-condylar plating in treatment of intercondylar supracondylar fractures of distal femur. Pan Arab J Ortho Trauma, 2007, 11(2): 26-34.
22.	Schatzker J. Fractures of the distal femur revisited. Clin Orthop Relat Res, 1998, (347): 43-56.
23.	Davison BL. Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop, 2003, 32(1): 27-30.
24.	Weng CJ, Wu CC, Feng KF, et al. High incidence of varus deformity in association with condylar buttress plates used to treat supraintercondylar fracture of the femur. Formosan Journal Musculoskeletal Disorders, 2012, 3(2): 50-55.
25.	Sié EJ, Mobiot CA, Traoré A, et al. Distal femoral fractures treated with condylar buttress plate in a West African hospital. J Clin Orthop Trauma, 2012, 3(2): 98-102.
26.	Koval KJ, Hoehl JJ, Kummer FJ, et al. Distal femoral fixation: a biomechanical comparison of the standard condylar buttress plate, a locked buttress plate, and the 95-degree blade plate. J Orthop Trauma, 1997, 11(7): 521-524.
27.	Vandenbussche E, LeBaron M, Ehlinger M, et al. Blade-plate fixation for distal femoral fractures: a case-control study. Orthop Traumatol Surg Res, 2014, 100(5): 555-560.
28.	Schatzker J, Mahomed N, Schiffman K, et al. Dynamic condylar screw: a new device. A preliminary report. J Orthop Trauma, 1989, 3(2): 124-132.
29.	Petsatodis G, Chatzisymeon A, Antonarakos P, et al. Condylar buttress plate versus fixed angle condylar blade plate versus dynamic condylar screw for supracondylar intra-articular distal femoral fractures. J Orthop Surg (Hong Kong), 2010, 18(1): 35-38.
30.	Massoud EI. Fixation of distal femoral fractures: Restoration of the knee motion. Ulus Travma Acil Cerrahi Derg, 2015, 21(3): 197-203.
31.	Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma, 2012, 26(6): 327-332.
32.	Petsatodis G, Chatzisymeon A, Antonarakos P, et al. Condylar buttress plate versus fixed angle condylar blade plate versus dynamic condylar screw for supracondylar intra-articular distal femoral fractures. Orthop Surg (Hong Kong), 2010, 18(1): 35-38.
33.	Kao FC, Tu YK, Su JY, et al. Treatment of distal femoral fracture by minimally invasive percutaneous plate osteosynthesis: comparison between the dynamic condylar screw and the less invasive stabilization system. Trauma, 2009, 67(4): 719-726.
34.	Beltran MJ, Gary JL, Collinge CA. Management of distal femur fractures with modern plates and nails: state of the art. J Orthop Trauma, 2015, 29(4): 165-172.
35.	Gwathmey FW, Jones-Quaidoo SM, Kahler D, et al. Distal femoral fractures: current concepts. J Am Acad Orthop Surg, 2010, 18 (10): 597-607.
36.	MullerME, Allgower M, Schneider R, et al. Manual of Internal fixation: techniques reommended by the AOASIF Group. New York: Springer-Verlag, 1990: 131-137.
37.	Hierholzer C, Von Ruden C, Potzel T, et al. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: a retrospective analysis. Indian J Orthop, 2011, 45(3): 243-250.
38.	Smith TO, Hedges C, MacNair R, et al. The clinical and radiological outcomes of the LISS plate for distal femoral fractures: a systematic review. Injury, 2009, 40(10): 1049-1063.
39.	Canale ST, Beaty JH. Campbell's operative orthopaedics. 11th ed. Singapore: Elsevier, 2009: 2499.
40.	Guyenet PG, Javory AF, Beaujouan JC, et al. Are locking constructs in distal femoral fractures always best: a prospective multicenter randomized controlled trial comparing the less invasive stabilization system with the minimally invasive dynamic condylar screw system. J Orthop Trauma, 2015, 84(2): 227-244.
41.	Tank JC, Schneider PS, Davis E, et al. Early mechanical failures of the synthes variable angle locking distal femur plate. J Orthop Trauma, 2016, 30(1): e7-e11.
42.	Henderson CE, Lujan TJ, Kuhl LL, et al. 2010 Mid-America orthopaedic association physician in training award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res, 2011, 469(6): 1757-1765.
43.	Erhardt JB, Vincenti M, Pressmar J, et al. Midterm results of distal femoral fractures treated with a polyaxial locking plate: a multi-center study. Open Orthop J, 2014, 8(1): 34-40.
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51.	Lujan TJ, Henderson CE, Madey SM, et al. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma, 2010, 24(3): 156-162.
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54.	Bottlang M, Schemitsch CE, Nauth A, et al. Biomechanical concepts for fracture fixation. J Orthop Trauma, 2015, 29 Suppl 12: S28-S33.
55.	Doornink J, Fitzpatrick DC, Madey SM, et al. Far cortical locking enables flexible fixation with periarticular locking plates. J Orthop Trauma, 2011, 25(2): S29-S34.
56.	Ries Z, Hansen K, Bottlang M, et al. Healing results of periprosthetic distal femur fractures treated with far cortical locking technology: a preliminary retrospective study. Iowa Orthop J, 2013, 33: 7-11.
57.	Bottlang M, Fitzpatrick DC, Sheerin D, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma, 2014, 28(4): 181-188.
58.	Adams JD Jr, Tanner SL, Jeray KJ. Far cortical locking screws in distal femur fractures. Orthopedics, 2015, 38(3): e153-e156.
59.	Ricci WM, Streubel PN, Morshed S, et al. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma, 2014, 28(2): 83-89.
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1. Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, et al. Distal femoral fractures: current concepts. J Am Acad Orthop Surg, 2010, 18(10): 597-607.
2. Link BC, Babst R. Current concepts in fractures of the distal femur. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 11-20.
3. Pietu G, Lebaron M, Flecher X, et al. Epidemiology of distal femur fractures in France in 2011-12. Orthop Traumatol Surg Res, 2014, 100(5): 545-548.
4. Kammerlander C, Riedmuller P, Gosch M, et al. Functional outcome and mortality in geriatric distal femoral fractures. Injury, 2012, 43(7): 1096-1101.
5. Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma, 2012, 26(6): 327-332.
6. Stewart MJ, Sisk TD, Wallace SL. Fractures of the distal third of the femur: a comparison of methods of treatment. J Bone and Joint Surg, 1966, 48(4): 784-807.
7. Link BC, Babst R. Current concepts in fractures of the distal femur. Acta Chir Orthop Traumatol Cech, 2012, 79(1): 11-20.
8. Scalea TM, Boswell SA, Scott JD, et al. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma, 2000, 48(4): 613-623.
9. Pape HC, Hildebrand F, Pertschy S, et al. Changes in the management of femoral shaft fractures in polytrauma patients: from early total care to damage control orthopedic surgery. J Trauma, 2002, 53(3): 452-462.
10. Sala F, Capitani D, Castelli F, et al. Alternative fixation method for open femoral fractures from a damage control orthopaedics perspective. Injury, 2010, 41(2): 161-168.
11. Carroll EA, Koman LA. External fixation and temporary stabilization of femoral and tibial trauma. J Surg Orthop Adv, 2011, 20(1): 74-81.
12. Parekh AA, Smith WR, Silva S, et al. Treatment of distal femur and proximal tibia fractures with external fixation followed by planned conversion to internal fixation. Trauma, 2008, 64(3): 736-739.
13. Ali F, Saleh M. Treatment of isolated complex distal femoral fractures by external fixation. Injury, 2000, 31(3): 139-146.
14. El-Tantawy A, Atef A. Comminuted distal femur closed fractures: a new application of the Ilizarov concept of compression-distraction. Eur J Orthop Surg Traumatol, 2015, 25(3): 555-562.
15. Cavusoglu AT, Ozsoy MH, Dincel VE, et al. The use of a low-profile Ilizarov external fixator in the treatment of complex fractures and non-unions of the distal femur. Acta Orthop Belg, 2009, 75(2): 209-218.
16. Bedes L, Bonnevialle P, Ehlinger M, et al. External fixation of distal femoral fractures in adults' multicentre retrospective study of 43 patients. Orthop Traumatol Surg Res, 2014, 100(8): 867-872.
17. Oh JK, Hwang JH, Sahu D, et al. Complication rate and pitfalls of temporary bridging external fixator in periarticular communited fractures. Clin Orthop Surg, 2011, 3(1): 62-68.
18. Hutson JJ Jr, Zych GA. Treatment of comminuted intraarticular distal femur fractures with limited internal and external tensioned wire fixation. J Orthop Trauma, 2000, 14(6): 405-413.
19. Hassankhani EG, Birjandinejad A, Kashani F, et al. Hybrid external fixation for open severe comminuted fractures of the distal femur. Surg Sci, 2013, 4(2): 176-183.
20. 张亚狮, 王建, 孙竞群. 股骨下端复杂骨折内固定方法的选择. 骨与关节损伤杂志, 2002, 17(4): 269-271.
21. Nagy HM, Mehy EE, Issa KH. Butttress-condylar plating in treatment of intercondylar supracondylar fractures of distal femur. Pan Arab J Ortho Trauma, 2007, 11(2): 26-34.
22. Schatzker J. Fractures of the distal femur revisited. Clin Orthop Relat Res, 1998, (347): 43-56.
23. Davison BL. Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop, 2003, 32(1): 27-30.
24. Weng CJ, Wu CC, Feng KF, et al. High incidence of varus deformity in association with condylar buttress plates used to treat supraintercondylar fracture of the femur. Formosan Journal Musculoskeletal Disorders, 2012, 3(2): 50-55.
25. Sié EJ, Mobiot CA, Traoré A, et al. Distal femoral fractures treated with condylar buttress plate in a West African hospital. J Clin Orthop Trauma, 2012, 3(2): 98-102.
26. Koval KJ, Hoehl JJ, Kummer FJ, et al. Distal femoral fixation: a biomechanical comparison of the standard condylar buttress plate, a locked buttress plate, and the 95-degree blade plate. J Orthop Trauma, 1997, 11(7): 521-524.
27. Vandenbussche E, LeBaron M, Ehlinger M, et al. Blade-plate fixation for distal femoral fractures: a case-control study. Orthop Traumatol Surg Res, 2014, 100(5): 555-560.
28. Schatzker J, Mahomed N, Schiffman K, et al. Dynamic condylar screw: a new device. A preliminary report. J Orthop Trauma, 1989, 3(2): 124-132.
29. Petsatodis G, Chatzisymeon A, Antonarakos P, et al. Condylar buttress plate versus fixed angle condylar blade plate versus dynamic condylar screw for supracondylar intra-articular distal femoral fractures. J Orthop Surg (Hong Kong), 2010, 18(1): 35-38.
30. Massoud EI. Fixation of distal femoral fractures: Restoration of the knee motion. Ulus Travma Acil Cerrahi Derg, 2015, 21(3): 197-203.
31. Vallier HA, Immler W. Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma, 2012, 26(6): 327-332.
32. Petsatodis G, Chatzisymeon A, Antonarakos P, et al. Condylar buttress plate versus fixed angle condylar blade plate versus dynamic condylar screw for supracondylar intra-articular distal femoral fractures. Orthop Surg (Hong Kong), 2010, 18(1): 35-38.
33. Kao FC, Tu YK, Su JY, et al. Treatment of distal femoral fracture by minimally invasive percutaneous plate osteosynthesis: comparison between the dynamic condylar screw and the less invasive stabilization system. Trauma, 2009, 67(4): 719-726.
34. Beltran MJ, Gary JL, Collinge CA. Management of distal femur fractures with modern plates and nails: state of the art. J Orthop Trauma, 2015, 29(4): 165-172.
35. Gwathmey FW, Jones-Quaidoo SM, Kahler D, et al. Distal femoral fractures: current concepts. J Am Acad Orthop Surg, 2010, 18 (10): 597-607.
36. MullerME, Allgower M, Schneider R, et al. Manual of Internal fixation: techniques reommended by the AOASIF Group. New York: Springer-Verlag, 1990: 131-137.
37. Hierholzer C, Von Ruden C, Potzel T, et al. Outcome analysis of retrograde nailing and less invasive stabilization system in distal femoral fractures: a retrospective analysis. Indian J Orthop, 2011, 45(3): 243-250.
38. Smith TO, Hedges C, MacNair R, et al. The clinical and radiological outcomes of the LISS plate for distal femoral fractures: a systematic review. Injury, 2009, 40(10): 1049-1063.
39. Canale ST, Beaty JH. Campbell's operative orthopaedics. 11th ed. Singapore: Elsevier, 2009: 2499.
40. Guyenet PG, Javory AF, Beaujouan JC, et al. Are locking constructs in distal femoral fractures always best: a prospective multicenter randomized controlled trial comparing the less invasive stabilization system with the minimally invasive dynamic condylar screw system. J Orthop Trauma, 2015, 84(2): 227-244.
41. Tank JC, Schneider PS, Davis E, et al. Early mechanical failures of the synthes variable angle locking distal femur plate. J Orthop Trauma, 2016, 30(1): e7-e11.
42. Henderson CE, Lujan TJ, Kuhl LL, et al. 2010 Mid-America orthopaedic association physician in training award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res, 2011, 469(6): 1757-1765.
43. Erhardt JB, Vincenti M, Pressmar J, et al. Midterm results of distal femoral fractures treated with a polyaxial locking plate: a multi-center study. Open Orthop J, 2014, 8(1): 34-40.
44. El-Zayat BF, Ruchholtz S, Efe T, et al. NCB-plating in the treatment of geriatric and periprosthetic femoral fractures. Orthop Traumatol Surg Res, 2012, 98(7): 765-772.
45. Hanschen M, Aschenbrenner IM, Fehske K, et al. Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial. Int Orthop, 2014, 38(4): 857-863.
46. Bottlang M, Doornink J, Lujan TJ, et al. Effects of construct stiffness on healing of fractures stablized with locking plates. J Bone Joint Surg (Am), 2010, 92 Suppl 2: 12-22.
47. Kubiak EN, Fulkerson E, Strauss E, et al. The evolution of locked plates. J Bone Joint Surg (Am), 2006, 88 Suppl 4: 189-200.
48. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg (Br), 2002, 84(8): 1093-1110.
49. Uhthoff HK, Poitras P, Backman DS. Internal plate fixation of fractures: short history and recent developments. J Orthop Sci, 2006, 11(2): 118-126.
50. Bottlang M, Lesser M, Koerber J, et al. Far cortical locking can improve healing of fractures stabilized with locking plates. J Bone Joint Surg (Am), 2010, 92(7): 1652-1660.
51. Lujan TJ, Henderson CE, Madey SM, et al. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma, 2010, 24(3): 156-162.
52. Laeblon T. Biomechanics of far cortical locking. J Orthop Trauma, 2011, 25(6): e60.
53. Bottlang M, Doornink J, Fitzpatrick DC, et al. Far cortical locking can reduce stiffness of locked plating constructs while retaining construct strength. J Bone Joint Surg (Am), 2009, 91(8): 1985-1994.
54. Bottlang M, Schemitsch CE, Nauth A, et al. Biomechanical concepts for fracture fixation. J Orthop Trauma, 2015, 29 Suppl 12: S28-S33.
55. Doornink J, Fitzpatrick DC, Madey SM, et al. Far cortical locking enables flexible fixation with periarticular locking plates. J Orthop Trauma, 2011, 25(2): S29-S34.
56. Ries Z, Hansen K, Bottlang M, et al. Healing results of periprosthetic distal femur fractures treated with far cortical locking technology: a preliminary retrospective study. Iowa Orthop J, 2013, 33: 7-11.
57. Bottlang M, Fitzpatrick DC, Sheerin D, et al. Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma, 2014, 28(4): 181-188.
58. Adams JD Jr, Tanner SL, Jeray KJ. Far cortical locking screws in distal femur fractures. Orthopedics, 2015, 38(3): e153-e156.
59. Ricci WM, Streubel PN, Morshed S, et al. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma, 2014, 28(2): 83-89.
60. Barei DP, Beingessner DM. Open distal femur fractures treated with lateral locked implants: union, secondary bone grafting, and predictive parameters. Orthopedics, 2012, 35(6): e843-e846.
61. Henderson CE, Kuhl LL, Fitzpatrick DC, et al. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma, 2011, 25 Suppl 1: S8-S14.
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