Table 3.
Indications, surgical techniques and intraoperative parameters
| Study | Inclusion/exclusion criteria | Incision/implant | Bone graft (%) | Blood loss (ml) | Operative time |
|---|---|---|---|---|---|
| Sanders 1991, USA | Supracondylar fracture with intracondylar extension (> 18 years, C2.3, C3.3) |
Incision: single-incision by tibial tubercle osteotomy 2, double incision (lateral and medial approach) Implant: seven lateral condylar buttress plate and medial plate |
Bone graft from the iliac crest applied in all patients (100%) | – |
A single incision with TT osteotomy: 6 h 25 min (385 min) Dual incision: 6 h (360 min) Two-stage surgery: 3 h 30 min for lateral plate and 2 h 30 min for medial plate |
| Chapman 1999, USA | Supracondylar femur fracture nonunion following fracture or osteotomy (≥ 5 mo to 36 mo) |
Incision: anterior parapatellar approach of Henry 10, lateral approach 3 Implant: Lateral: 95° DCS/dome plunger screw 7, condylar buttress plate 4, DCP/Alta broad plate: two Anteromedial plate: DCP/Alta side plate in all |
Bone graft from the iliac crest applied in all patients (100%) | – | – |
| Ziran et al. 2002, USA | Displaced C2 and C3 (AO classification) distal femoral fractures |
Incision: anterior approach (lateral parapatellar approach) Implant: 18 blade plates and 18 condylar plates used laterally, ten reconstruction and 25 DC plates used anteriorly |
Bone grafting with allograft and demineralized bone matrix (DBM) was used in all but eight femurs | – | – |
| Khalil 2012, Egypt | Polytrauma, closed, comminuted distal femur fractures (C3) |
Incision: modification of the extensile olerud approach, (with TT osteotomy) Implant: contoured medial plate (reconstruction plate in 8, semitubular plate in 4) |
Augmentation of the bony defects by bone grafting (iliac) in all | – | – |
| Dugan 2013, USA | Polytrauma, open fractures, staged procedure, comminuted distal femur fracture (C, C3) |
Incision: extensile anterior approach as described by Henry Implant: lateral locked plate and medial side small fragment combi-holes |
Autologous graft from iliac crest/other sites in obese pts)BMP-2/BMP-7, in some cases additional allograft chips applied | – | – |
| Holzman 2016, USA | Distal femoral fracture nonunion, defined as an unhealed fracture with no radiographic signs of osseous union at a mean of 16 months following previously surgery with lateral plate |
If the lateral plate was stable: medial locking plate through the medial parapatellar approach If lateral plate had failed: two-stage reconstruction. First, the lateral plate was removed and a new lateral locking plate fixed through the lateral approach. Second, consisted of medial locked plating and bone grafting through medial parapatellar approach (median after 91 d) |
Autogenous BG (16 PICBG, 6 RIA) in 21 pts (91.3%, additional BMP-7 in 4 and BMP-2 in 2), 2 DBM(8.69%) | – | – |
| Steinberg 2017, Israel |
Non–union, nonunion following hardware failure, poor bone quality, Type A3, C3, according to AO/OTA classification and very low supracondylar and periprosthetic fractures |
Incision: double incision (lateral and medial) Implant: lateral locked plate, medial locked/ non-locking plate |
– | – | – |
| Imam 2017, Egypt |
Patients > 18 years, presenting with type C3 distal femoral fractures, with no absolute medical contraindications to surgery, without associated neurovascular compromise prior to surgery Patients with preoperative neuromuscular compromise in the symptomatic extremity, and those presenting with other types of distal femoral fractures or pathological fractures were excluded |
Incision: extended anterior incision (medial parapatellar) Implant: lateral distal femoral locked plate with a countered medial plate non-locking (proximal tibial plate in ten cases and distal tibial plate in six cases) |
Bone grafting (iliac) required in 10 cases (62.5%), small articular osteochondral fragment fixation was performed using surgical sutures or mosaicplasty (12.5%, 2/16) | 565.6 ± 99.5 (400–750) |
213.6 ± 25.8 min (160–260) |
| Bai 2018,China | Fractures within 9 cm of the articular surface of distal femoral(open/closed), (C1, C2 and C3) |
Single plate: Lateral locked plate through the anterolateral incision Double plate: medial and lateral incision. Lateral locked plate and anatomical plate on the medial side of the distal femur or upper limb compressing plate |
Single plate: 19 (40.4%) bone grafting-autogenous iliac bone 2 (4.2%), artificial bone 15 (31.3%), combined bone grafting 2 (4.2%) Double plate: 11 (91.7%) bone grafting- autogenous iliac bone 7 (58.3%), artificial bone 1 (8.3%), combined bone grafting 3 (25.0%) (p = 0.002) |
Single plate: 513 Double plate: 814 (p = 0.270) |
Single plating 145 min Double plating 180 min (p = 0.170) |
| Metwaly 2018, Egypt |
Osteoporotic geriatric patients (> 60yrs) with isolated distal femoral fractures were included Poly traumatized, open fractures, fractures type 33-A1, 33-A2, and 33-B were excluded |
Incision: midline anterior skin incision was done followed by either a medial or lateral parapatellar approach Implant: locked lateral distal femoral plate and medial locked plate |
No primary grafting, autologous bone graft needed in 4 (17.4%) cases after 6 months for showing no signs of union progression | – |
148 min (117–193 min) |
| Zhang 2018, China |
AO/OTA 33A2, 33A3 in adult patients, were included Exclusion criteria: polytrauma, pathological fracture, malignancy-related fracture, periprosthetic fracture |
Single plate group: lateral distal femur locking plate Double plating group: lateral and medial incision (through minimal dissection of vastus medialis), lateral locking plate with medial DCP |
– |
Single plate group: 220.00 ± 45.51 Double plate group: 228.57 ± 50.81 (p = 0.636) |
Single plate group: 88.00 ± 13.99 min Double plate group: 104.29 ± 9.39 min (p = 0.001) |
| Bologna 2019,USA |
Patients > 18 years of age with 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 |
Single plating: lateral distal femoral locking plate using a lateral approach Dual plating: extensile parapatellar approach, Lateral locked plate, a straight locking plate contoured to the medial surface |
– | – | – |
D days, weeks weeks, mo months, MUA manipulation under anesthesia, ORIF open reduction and internal fixation, HO heterotopic ossification