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Analysis of 101 Mechanical Failures in Distal Femur Fractures Treated With 3 Generations of Precontoured Locking Plates. Journal of orthopaedic trauma Reeb, A. F., Collinge, C. A., Rodriguez-Buitrago, A. F., Archdeacon, M. T., Beltran, M. J., Gardner, M. J., Jeray, K. J., Miller, A. N., Crist, B. D., Sems, S. A., Shah, N. S., Fogel, N., Tibbo, M. 2022

Abstract

OBJECTIVES: To evaluate mechanical treatment failure in a large patient cohort sustaining a distal femur fracture treated with a distal femoral locking plate (DFLP).DESIGN: This retrospective case-control series evaluated mechanical treatment failures of DFLPs.SETTING: 8 Level I trauma centers from 2010 to 2017.PATIENTS AND PARTICIPANTS: 101 patients sustaining an OTA/AO 33-A and C distal femur fractures treated with DFLP that experienced mechanical failure.INTERVENTION: Treatment of a distal femur fracture with a DFLP, affected by mechanical failure (implant failure by loosening or breakage).MAIN OUTCOME MEASURE: Injury and DFLP details; modes and timing of failure were studied.RESULTS: 146 nonunions were found overall (13.4%) including 101 mechanical failures (9.3%). Failures occurred in different manners, locations and times depending on the DFLP. For example, 33 of 101 SS plates (33%) failed by bending or breaking in the working length while no Ti plates failed here(P<0.05). 11 of 12 failures with Ti-LISS (92%) occurred by lost shaft fixation, mostly by loosening of unicortical screws (91%). 16 of 44 VA-LCP failures (36%) occurred at the distal plate-screw junction, while only 5 of 61 other DFLPs (8%) failed this way (P<0.05). Distal failures occurred on average at 23.7 weeks compared to others that occurred at 38.4 weeks (P<0.05). VA-LCP distal screw-plate junction failures occurred earlier (mean 21.4 weeks).CONCLUSION: Nonunion and mechanical failure occurred in 14% and 9% of patients respectively in this large series of distal femur fracture treated with a DFLP. The mode, location, presence of a prosthesis, and timing of failure varied depending on the characteristics of DFLP. This information should be used to optimize implant usage and design to prolong the period of stable fixation before potential implant failures occur in patients with a prolonged time to union.LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

View details for DOI 10.1097/BOT.0000000000002460

View details for PubMedID 35862769