Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis

Sujit Kumar Tripathy; Narayan Prasad Mishra; Paulson Varghese; Sibasish Panigrahi; Prabhudev Prasad Purudappa; Akshay Goel; Ramesh Kumar Sen

doi:10.1007/s43465-021-00489-0

Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis

Indian J Orthop. 2021 Aug 23;56(2):183-207. doi: 10.1007/s43465-021-00489-0. eCollection 2022 Feb.

Authors

Sujit Kumar Tripathy¹, Narayan Prasad Mishra¹, Paulson Varghese¹, Sibasish Panigrahi¹, Prabhudev Prasad Purudappa², Akshay Goel³, Ramesh Kumar Sen⁴

Affiliations

¹ Department of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, 751019 India.
² Department of Orthopedics, Boston VA Medical Centre, 150 S Huntington Avenue, Boston, MA 02130 USA.
³ Joan C Edwards School of Medicine, Marshall University, Huntington, WV USA.
⁴ Department of Orthopaedics, Max Hospital, Mohali, India.

Abstract

Introduction: Although lateral locking plate has shown promising results in distal femur fracture, there are high rates of varus collapse and implant failure in comminuted metaphyseal and articular fractures. This systematic review evaluates the functional outcomes and complications of dual plating in the distal femur fracture.

Materials and methods: Manual and electronic search of databases (PubMed, Medline Embase and Cochrane Central Register of Controlled Trials) was performed to retrieve studies on dual plate fixation in the distal femur fracture. Of the retrieved 925 articles, 12 were included after screening.

Results: There were one randomized-controlled, four prospective and seven retrospective studies. A total of 287 patients with 292 knees were evaluated (dual plating 213, single plating 76, lost to follow-up 3). The nonunion and delayed union rates following dual plate fixations were up to 12.5% and 33.3%, respectively. The mean healing time ranged from 11 weeks to 18 months. Good to excellent outcome was observed in 55-75% patients. There was no difference between the single plate and dual plate fixation with regards to the functional outcomes (VAS score, Neer Score and Kolmert's standard) and complications. Pooled analysis of the studies revealed a longer surgical duration (MD - 16.84, 95% CI - 25.34, - 8.35, p = 0.0001) and faster healing (MD 5.43, 95% CI 2.60, 8.26, p = 0.0002) in the double plate fixation group, but there was no difference in nonunion rate (9.2% vs. 0%, OR 4.95, p = 0.13) and blood loss (MD - 9.86, 95% CI - 44.97, 25.26, p = 0.58).

Conclusion: Dual plating leads to a satisfactory union in the comminuted metaphyseal and articular fractures of the distal femur. There is no difference between the single plate and dual plate with regards to nonunion rate, blood loss, functional outcomes and complications. However, dual fixation leads to faster fracture healing at the cost of a longer surgical duration.

Keywords: Comminution; metaphysis; Distal femur plate; Double plate; Locking plate; Medial plate; Periprosthetic fracture; Supracondylar femur fracture.

Publication types

Review