Гений oртопедии (Sep 2020)
Anatomical and clinical justification of a minimally invasive technique for implantation an additional medial plate for bone osteosynthesis in patients with fractures of the distal femur
Abstract
Introduction Traditional lateral plate osteosynthesis for distal femoral fractures does not provide sufficient stabilization in comminuted fractures due to a lack of medial support. Materials and methods Study on 16 lower limbs of 9 cadavers was conducted. We performed osteosynthesis of distal femur with precontoured medial plate implantation using a minimally invasive surgical technique. Then, the soft tissues were dissected to explore an exact location of the medial plate and the distances between plate and crucial anatomic structures of the distal femur. Fifteen patients underwent surgical treatment of distal femoral fractures with a loss of medial stability (AO/OTA classification 33-A3, 33-C2, 33-C3 fracture types) using the method of low invasive double-plating. Follow-up examinations were performed after 6 to 12 months. Results were evaluated using KSS and Lysholm scales. Results Cadaver study showed safety and feasibility of described minimally invasive osteosynthesis of distal femoral fractures method. We did not encounter specific complications associated with medial plate implantation during surgery. All fractures healed 12 months after surgery. The functional outcomes were good and excellent in more than 70 % of cases according to KSS and Lysholm scales. Discussion Fracture management in the segments with eccentric axial load is still problematic. The double-plating technique is a promising method which can be used by trauma surgeons in distal femoral fractures without medial stability. However, further clinical research to prove safety and feasibility of this method of distal femoral fracture fixation in comparison with alternate ostheosynthesis techniques is needed to determine more specific indications for its application.
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