Primary fibular grafting with double plating has higher union rates in distal femur fractures among elderly

Fady M. Ibrahim et al found in a study that - Primary fibular grafting combined with double plating of comminuted distal femur fractures in patients above 70 years is an effective technique with higher rates of union and lower re-operation rates compared to other fixation modalities.

The incidence of elderly population sustaining distal femoral fractures had been increasing in the last two decades with a changing epidemiological pattern as regards female to male ratio (2:1). Posing a major problem, nonunion after lateral plating alone was reported in up to 21% of the cases, many studies stated that metaphyseal comminution, poor bone quality, and inadequate fixation are the main causes for nonunion reflecting the necessity to deal with these problems. Tendency to fail in varus is another major problem, also in cases of comminution.

Using primary fibular grafting with stable rigid double plating fixation after anatomical reduction of the articular and metaphyseal fractures allowing an early range of motion and rehabilitation may decrease the reportedly high rates of nonunion, malunion, varus collapse, and the need for secondary surgery in this fragile population.

A retrospective study on 30 elderly patients with comminuted distal femoral fractures managed by primary fibular grafting and double plating through an anterior midline approach has been conducted.

Only isolated distal femoral fractures type 33-A3, 33-C2, and 33-C3 were included. The patient's mean age was 75.3 years. Evaluation included operative time, blood loss, time to union, knee range of motion, Sanders scoring, and presence of complications.

The results of the study were:

• The average follow-up period was 26.6 months.

• Mean intraoperative blood loss was 401 ml, and mean operative time was 216 min.

• All patients had a knee range of motion (90–120°) during follow-up.

• Time for union ranged from 16 to 23 weeks with a mean of 18.4 weeks, with no cases of non-union.

• A total of 22 patients (73.3%) showed excellent functional outcomes, and the remaining eight (26.7%) showed good functional outcomes according to the Sanders scoring system.

• Only two cases (6.6%) had superficial wound infections managed conservatively.

• No post-operative deformity, loss of reduction, or implant failure was observed until the end of follow-up period.

The authors concluded that - Primary fibular grafting combined with dual plate fixation of distal femur fractures in elderly patients does appear to be a safe, easy, and effective technique, and probably provides an improved healing environment for these fractures.

Further reading:

Primary fibular grafting combined with double plating in distal femur fractures in elderly patients.

Fady M. Ibrahim, Ahmed K. El Ghazawy, Mohammed A. Hussien.

International Orthopaedics (2022) 46:2145–2152

https://doi.org/10.1007/s00264-022-05441-x