THE BIO-LOGIC USE OF PLATE AND SCREWS IN THE TREATMENT OF MULTIFRAGMENTARY COMMINUTED FRACTURES OF FEMUR

Abstract

Introduction: Modern nailing techniques are the gold standard in the treatment of multifragmentary fractures of femur. Nevertheless, the use of plate and screws, in accordance with the principles of biologic fixation, remains an effective alternative.

Aim: The purpose of this retrospective study is the evaluation of the results of biologic fixation, with plate and screws, of multifragmentary femoral fractures.

Material – Methods: Our material consists of 32 multifragmentary subtrochanteric and diaphyseal femoral fractures that were treated in our department, between 1992 and 2000, in accordance with the principles of biologic fixation with plates and screws. All fractures were reduced indirectly with traction on the fracture table without any direct manipulation at the comminution zone. Emphasis was given to the restoration of the proper length, axial and rotational alignment of each fracture. The exposure of the femur was done proximally and distally to the fracture site through two separate incisions of the vastus lateralis near its insertion to the linea aspera. There was no direct exposure of the comminution zone. The fixation was done with a long bridge plate, without the use of interfragmentary screws. No iliac bone graft was used in the primary procedures.

Results: Twenty nine of the fractures (91%) united, without serious complications, within 3–5 months. One fracture failed to unite and had to be operated upon with a new plate and screws and additional bone grafting. In another one, the plate was bent, due to early weight bearing, and had to be exchanged with a nail. The third fracture united in a mild varus position, as some of the screws were broken and the plate was mildly bent.

Conclusions: The bio-“logic” use of plate and screws in the treatment of multifragmentary fractures of femur gives excellent results, comparable with those of the modern nailing techniques.