Review Question - QID 3467

The injury shown in Figures A-D represents a comminuted metaphyseal distal femur fracture with a sagittally oriented intra-articular split in osteoporotic bone. Because of the intra-articular nature of this injury, the best fixation construct for treatment of this fracture in an otherwise healthy and active patient is lag screw fixation followed by locked plate application.

Egol et al performed a systematic review of the literature to compare and contrast the function and roles of conventional unlocked plates to locked plates in fracture fixation. They concluded that locked plates may increasingly be indicated for indirect fracture reduction, diaphyseal/metaphyseal fractures in osteoporotic bone, bridging severely comminuted fractures, and the plating of fractures where anatomical constraints prevent plating on the tension side of the bone.

Perren et al discuss the treatment of osteoporotic fractures in the elderly population. They state that in this group of patients, plating with locked screws improve the biology and the mechanics of internal fixation. Furthermore, when this fixation method is used as an 'internal ex fix' (bridging construct) it may stimulate early callus formation because of the inherent flexibility of the construct.

Illustrations A and B show intraoperative fluoroscopic images during fracture fixation. Illustration C shows an AP radiograph of the distal femur 3 months after fixation with a locked plate construct.