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Accurate fixation of complicated comminuted femur fracture with customized LCP referencing a life-size 3D-printed model: a case report.

ABSTRACT: Fixation of a comminuted mid-distal femur fracture is challenging in clinical practice due to a high degree of comminution and malformation. Here we describe a procedure involving a series of steps for accurate fracture fixation in a patient diagnosed with comminuted mid-distal femur fracture. Emergency traction of the tibia tubercle was initially performed using a large distractor for temporary external fixation to maintain the femoral force line and to reduce intraoperative fractures. A three-dimensional printed model was then used as a preoperative simulation tool to preshape the customized locking plate, reducing the operation difficulty and improving surgical accuracy. Finally, the comminuted femur fracture was treated with the minimally invasive percutaneous plate osteosynthesis technique for maximum protection of bone fracture fragments and the surrounding blood supply. No postoperative complications were observed at the 3-year follow-up when the plate was removed. This procedure offers new possibilities for orthopedic surgeries and should be considered as an option for accurate fixation of comminuted mid-distal femur fractures.

SUBMITTER: Liu H

PROVIDER: S-EPMC7210172 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Accurate fixation of complicated comminuted femur fracture with customized LCP referencing a life-size 3D-printed model: a case report.

Liu He H Yuan Baoming B Yu Tong T Ren Guangkai G Zhang Yan Y Wu Yang Y Liu Yadong Y Peng Chuangang C Wu Dankai D

Annals of translational medicine 20200401 7

Fixation of a comminuted mid-distal femur fracture is challenging in clinical practice due to a high degree of comminution and malformation. Here we describe a procedure involving a series of steps for accurate fracture fixation in a patient diagnosed with comminuted mid-distal femur fracture. Emergency traction of the tibia tubercle was initially performed using a large distractor for temporary external fixation to maintain the femoral force line and to reduce intraoperative fractures. A three- ...[more]

PMID: 32395549

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Project description:PurposeThe treatment of distal femur fractures with extensive metaphyseal comminution is frequently complicated by high rates of nonunion and varus collapse. Dual plating with lateral and medial locking plates for these types of fractures has shown promising results in the recent literature. We hypothesize that dual plating of comminuted distal femur fractures leads to higher union rates and lower revision rates compared to an isolated lateral locking plate.MethodsA retrospective medical chart review between January 2015 and December 2017 was conducted. Inclusion criteria included patients 18 years of age and older who sustained a complex distal femur fracture (AO/OTA 33-C2/33-C3 or periprosthetic fracture with significant metaphyseal comminution) and at least 6 months of follow up. Patients with simple fracture patterns, alternative fixation methods, and inadequate follow up were excluded. All patients in the single plating group were treated with a lateral distal femoral locking plate using a lateral approach. In the patients treated with dual plating, an extensile parapatellar approach was utilized for fracture reduction and placement of an adjunctive medial plate. Demographic information, fracture types, injury severity score (ISS), medical comorbidities, type of surgical fixation, union rates, complications, knee range of motion, time to follow up, and need for revision surgery were extrapolated from the medical charts for analysis.ResultsTwenty-one patients were included in the study. Thirteen patients underwent single plate fixation and 8 underwent dual plate fixation. There were no significant differences in demographics, number of co-morbidities, fracture classification, or ISS between single and dual plate groups (p > 0.05 for all). There was a statistically significant difference in union rates between the single plate group (6 nonunions, 4 unions, and 3 delayed unions) and the dual plate group, with no nonunions or delayed unions (p = 0.0049). Although not statistically significant, 4 patients treated with single plating underwent revision ORIF, compared to none in the dual plating group (p = 0.13). There were no significant differences in time to follow up, time to full weight bearing, or infection rates (p > 0.1 for all).ConclusionBased on these results, the medial and lateral locked plating technique demonstrates a higher union rate, with possible lower rates of revision surgery, compared to a single lateral plate in highly comminuted distal femur fractures.Level of evidenceLevel 3. Retrospective Cohort Study.

Project description:This report describes a novel surgical technique for trans-articular external skeletal fixation (TA-ESF) of the hip to stabilize a rare, highly comminuted juxta-articular fracture of the proximal femoral segment involving the metaphysis and diaphysis in a cat. A 2-year-old, castrated male, Korean shorthair cat was admitted for a left femoral fracture caused by gunshot injury. Radiographs and computed tomography (CT) scans revealed a highly comminuted proximal femoral diaphyseal fracture that involved the femoral neck and the greater trochanter. The left femoral head was intact on CT. Under fluoroscopic guidance, an intramedullary Steinmann pin was placed to align the femur, and five positive-profile, end-threaded pins were placed in the left hemipelvis and distal femur. A triangulated frame of connecting bars was constructed using Steinmann pins and epoxy resin for TA-ESF. This secured the pins placed in the pelvis and femur as well as the intramedullary pin, providing proximal femoral stabilization by trans-articular fixation of the hip. The cat began placing weight on the left pelvic limb 4 days postoperatively, and progressively obtained near-normal limb function by day 112. The TA-ESF was partially dismantled to a linear tie-in construct on day 64 and was completely removed on day 161. Final radiographs on day 161 revealed lack of bone healing in the proximal segment, especially femoral head and neck, despite functional recovery of the injured leg. At one year postoperatively, the cat had normal limb function without any noticeable complications. On follow-up 29 months after surgery, the owner reported that the cat had normal limb function without any noticeable complications. Despite insufficient bone healing in the cat, TA-ESF of the hip allowed for satisfactory functional recovery of this challenging juxta-articular fracture of the proximal femur, which was not amenable to stabilization with a traditional non-load-sharing fixation system.

Dataset Information

Accurate fixation of complicated comminuted femur fracture with customized LCP referencing a life-size 3D-printed model: a case report.

Publications

Accurate fixation of complicated comminuted femur fracture with customized LCP referencing a life-size 3D-printed model: a case report.

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