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.
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