Application of cortical bone plate allografts combined with LISS plates for fixation of comminuted distal femur fractures

Abstract Background: At present, the management of comminuted distal femur fractures remains challenging for orthopedic surgeons. The aim of this study is to report a surgical treatment for comminuted distal femur fractures using supplementary medial cortical bone plate allografts in conjunction with the lateral less invasive stabilization system (LISS) plates, and to discuss the therapeutic effects of this treatment after long-term follow-up with patients. Patients and methods: From January 2009 to January 2014, the records of thirty-three patients who underwent supplementary medial cortical bone plate allografts combined with lateral LISS plate fixation were reviewed. Twenty-nine patients suffered from closed fractures and four had open fractures. Clinical and radiographic data were collected during regular post-operative follow-up visits. Functional outcomes were determined according to the special surgery knee rating scale (HSS) used at the hospital. Results: Thirty patients were followed for 13 to 73 months after surgery, with an average follow-up time of 31.3 months. The mean time to bone union was 5.4 months (range of 3-12 months) and the mean range of knee flexion was 105.6º (range of 80º-130º). Of the remaining patients, 10 had a score of “Excellent” while 10 had a score of “Good” (the proportion of “Excellent” and “Good” scores was 67.7%). Three patients had superficial or deep infections, one patient had nonunion that required bone grafting and one patient had post-traumatic knee arthritis. No loosening of fixation or refracture had occurred in any patient at the time of the last follow-up appointment. Conclusions: Based on these promising results, we propose that supplementary medial cortical bone plate allografts combined with lateral LISS plates fixation may be a good treatment option for comminuted distal femur fractures. This treatment choice not only resulted in markedly improved stability on the medial side of the femur, but also satisfactory outcomes for distal femoral fractures.