Supplementary medial plating for distal femoral fractures: a surgical technique with clinical outcomes

Presenter’s name (Last, First): Lee, Hai Sherng

Qualifications: MBBS, MTrau (Ortho)

Affiliations: John Hunter Hospital, New South Wales

Other authors:
Daniel P. Lewis / B Med (Dist), MTrau (Ortho) /John Hunter Hospital; Zsolt J. Balogh / MD, PhD, FRACS, FACS / John Hunter Hospital


Background / Introduction:
Distal femur fractures (DFF) are uncommon and occur in high-energy trauma and the elderly. Lateral-locked distal femur osteosynthesis constructs have been widely used, however non-union and hardware failure rates remain 4-25%. There are a lack of proprietary medial plate options available, which impacts on positioning the plate or screws in optimal locations for comminuted fractures. The aim of this study was to investigate the feasibility of using the LCP T-plate as a medial supplementary plate.

Patients / Methods:
A retrospective study was performed at a university-affiliated Level 1 Trauma Centre between January 2014-June 2022. Included cases were >16 years old, who underwent supplemental medial fixation via a medial subvastus approach with a Large Fragment LCP T-Plate, which was manually contoured and positioned proximal to the medial femoral condyle to buttress it and allow for optimal screw placement for fracture configuration. Both primary and revision cases were included. The primary outcome was union.



Fifteen patients were included:three acute fractures and twelve revisions. Mean age:52±19; 81% of cases were male and median follow-up was 57 weeks(IQR 30-98).The two most common fracture patterns were AO/OTA 33-C3(n=6) and 33-A3(n=4). Five patients had open fractures. Autologous iliac crest bone grafting was used in all but one case. Overall, fourteen cases achieved union(93%); median time to union: 29 weeks(IQR 18-48). Non-union occurred in one non-ambulatory patient with a below-knee amputation. Two complications included a deep infection of the medial wound which underwent two debridements, and a second patient who had a prominent screw removed;both patients achieved union.

Dual plating of distal femur fractures with a medial Large Fragment LCP T-Plate is safe and effective. It has added benefits over pre-contoured anatomic plates as it can be contoured specifically to each fracture to optimise screw placement and trajectory, are inexpensive and also readily available.

Level of Evidence & Study type: Level IV, Case series

Declarations of Conflict: No conflicts of interest