Table 3.

Results of the systematic review for double plating of distal femoral fractures

Title	Authors	Journal	Year	Level of evidence	Number of cases	Treatment	Mean follow-up (months)	Fracture healing	Complications	Functional outcome at final follow-up
Double-plating of comminuted, unstable fractures of the distal part of the femur	Sanders et al.	The Journal of Bone and Joint Surgery	1991	IV	n = 9 Mean age: 39 years Range of age: 21–75 years	Lag screw and condylar buttress plate lateral, in the distal part cancellous bone screws, medial plate and bone graft	26 (SD 2–34)	All 9 fractures healed in an average time of 6.7 months (SD 5–9 months)	n = 0	5 good and 4 fair functional results were achieved according to methods of Sanders et al. Flexion of the knee: 3 patients had < 90°, 5 patients 90°-100°, 1 patient > 100°. 1 patient was always pain free and none patient had pain at rest
Lateral and anterior plating of intra-articular distal femoral fractures treated via an anterior approach	Ziran et al.	Internantional Orthopedics	2002	IV	n = 36 displaced distal femoral fractures Mean age: n.a Range of age: n.a	Anterior approach and double-plating lateral plate (condylar or blade) and anterior plate (reconstruction or 3.5 mm dynamic compression)	7 (SD 3–44) two patients died during hospitalization, one patient was lost to follow-up	Uneventful healing by 16 weeks occurred in 24 of 36 cases 3 non-unions	n = 8 2 died during hospitalization (non-related cause to surgery), 3 non-unions 1 superficial wound infection 2 infection (1 of which resulted in amputation below the knee)	Mean arc of motion was from 5° (5°–35°) − 100° (20°–130°) flexion
Highly unstable complex C3-type distal femur fracture: can double plating via a modified Olerud extensile approach be a standby solution?	Khalil Ael-S et al.	Journal of Orthopedics and Traumatology	2012	IV	n = 12 Mean age: 33.5 years Range of age: 22–44 years	Ipsilateral iliac bone was draped for autografting Lateral locked distal femur plate Contoured medial plate (reconstruction plate in eight cases, semitubular plate in four cases) Lateral distal femur locked plate and a medial contoured plate through a modified Olerud extensile approach	13.7 (SD 11–18)	All cases had radiological healing. Mean healing time 18.3 months (SD 12–28 weeks) with 4 cases having a delayed union (more than 24 weeks)	n = 15 4 delayed unions (more than 24 weeks) 3 cases (25%) had mild pain at the iliac grafting donor site 2 cases (16.7%) had manipulation under general anaesthesia after 3 weeks from surgery due to manifest delay in rehabilitation response 2 superficial infections (16.7%), 2 delayed wound healings (16.7%) 2 delayed tibial tuberosity osteotomy healings for more than 12 weeks (16.7%)	7 of 12 cases had excellent and good results (58.4%); 3 cases had fair results (25%); 2 cases had poor results (16.7%) according to methods of Sanders et al
Double plating of intra-articular multifragmentary C3-type distal femoral fractures through the anterior approach	Imam et al.	European Journal of Orthopaedic Surgery & Traumatology	2017	IV	n = 16 supracondylar Femoral fracture type C3 Mean age: 36 years Range of age: 18–59 years	Countersunk cancellous screws size 4 or 6.5 mm followed by applying a distal femoral locked plate sub-musculary on the lateral surface of the condyle; application of contoured medial plate (proximal tibia in ten cases, distal tibia in six cases); bone grafting from the iliac bone	11.5 (SD 6–24)	Complete radiological union was 6.0 ± 3.5 months (SD 3–14 months) with one case having a delayed union	n = 4 1 nonunion (6.25%); 2 infections (12.5%); 1 needed revision (6.25%)	Eleven had well-to-excellent functional outcome (68.75%) Poor outcome in two patients (12.5%) according to methods of Sanders et al
Comparison of Clinical Efficacy of Lateral and Lateral and Medial Double-plating Fixation of Distal Femoral Fractures	Bai et al.	Scientific Reports	2018	IV	n = 60 distal femoral fractures n = 48 treated with lateral plate (single plate) n = 12 treated with lateral plate and medial plate (double plating) Mean age: n.a Range of age: n.a	Single-plate group Double plate group: after setting the lateral plate, if varus stress was positive and lateral collateral ligament rupture excluded, medial double plating was used	Single plate group: 15.2 Double plate group: 18.5	Single-plate group: union was achieved in 47 cases (97,9%) Mean time of healing: 14.3 Double plate group: union was achieved in all 12 cases 100% Mean time of healing: 18 months	Single-plate group: n = 1 1 non-union (2,1%), retreated with autologous iliac bone graft and lateral anatomical plate fixation, which then healed Double-plate group: n = 0	Single-plate group: excellent and good results in 39 of 48 cases (81.3%); fair results in 7 cases (14.6%) and poor results in 2 cases (4.2%) according to Kolmert´s standard Double-plate group: excellent and good results in 9 of 12 cases (75%); fair results in 2 cases (16.7%); poor results in 1 case (8.3%) according to Kolmert´s standard
Single-Incision Double-Plating Approach in the Management of Isolated, Closed Osteoporotic Distal Femoral Fractures	Metwaly et al.	Geriatric Orthopaedic Surgery and Rehabilitation (GOS)	2018	III	n = 23 distal osteoporotic femoral Fractures (AO 33-A3, 33-C1-3) Mean age: 69.6 years Range of age: 61–80 years	Medial: antishear plate (locked L-plate or medial distal femoral osteotomy locked plate) Lateral: long-locked lateral distal femoral plate minimally invasive percutaneous plate osteosynthesis (MIPPO)	14.1 SD (12–36)	Union was achieved in 19 cases (82.6%) 4 (17.4%) cases needed autologous bone graft after 6 months Mean time of union: 9 months (SD 3–12 months)	n = 9 (39.1%) 2 superficial infections 1 deep-vein thrombosis 6 screw breakage or cut-out in one of the plate fixations no loss of reduction	The mean EQ-5D-5 L score was 83.8 (72–92) 100 means the best health the patient can get and 0 means the worst health knee range of motion was 3°-5° less when compared to the contralateral nonfractured side