Exploring The Indication Of Using Lateral-Medial Plates For The Fixation Of Distal Femoral Fractures

Objective To explore the indication of using lateral-medial platesto fix the distal femoral fractures and observe the effectiveness and complications.Methods From March 2006 to April 2014,48 (23 male,25 female) and 12 (6 male,6 female) sides of distal femoral fractures were treated by single-plate and lateral-medial plates (double plates), respectively, with an average age of 49 and 46 years. During the surgery, after setting the lateral plate, lateral stress test of the knees were tested to decide whether the medial sides of the knees were stable. If the medial side was unstable, the medial buttress plate was needed to increase stability of the distal femoral fractures. Bone grafting was suggested when there is bone defect more than 1cm. Anticoagulant drugs, analgesic were routinely used after surgery. The active or passive knee motion exercise was started within 72 hours postoperatively. The patients were followed up at an average period of 15.9 months including the wound healing, loss of reduction, fracture union, the failure of the internal fixation wares and range of flexion and extension of knee. One year after operation, the function of knee was evaluated using the Kolmert standard.Results All the patients were followed up, and one of each group died of respiratory system diseases one and a half years after the operation. Among them,21 sides were younger than 40 years old,25 sides were more than 50 years old, the others are between them. The single plate group and the double plates group were followed up for a mean period of 15.2 and 18.5 months, with the fracture union occurred 14.3 and 18 months after surgery on average. The average fracture union time of two groups was not significantly different. The average operating times of single and double plates group were 145,180 minutes, and the mean bleeding volumes were 513,814 ml, respectively. The bleeding volume and operating time of the double plates group were not significantly different with those of the single plate group, but the ratio of fractures types and bone grafting rate were. All wound healed well. Among the 60 sides, one of the single plate group accepted a second operation for the failure of internal fixation and the others were not found failure of fixation wares, loss of reduction, knee varus deformity. Knee function was evaluated by Kolmert score standard, with excellent in 15 and 4 sides, good in 24 and 5 sides, fair in 7 and 2 sides, poor in 2 and 1 sidses respectively, in single plate and double plates groups. The difference of excellent and good rate between two groups was insignificant (p=0.692)Conclusions After setting the lateral plate for the distal femoral fractures, if the varus stress test of the knee is positive and the lateral collateral ligament rupture is excluded, lateral-medial plates were suggested for the stability of the fragments and the early motion of the knee. There was no significant difference in the fracture union time, operating time, bleeding volume during surgery and knee function between the two groups...