University Hospital of Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK; School of Engineering, University of Warwick, Coventry CV4 7AL.
University Hospital of Coventry & Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK.
Injury. 2022 Mar;53(3):1237-1240. doi: 10.1016/j.injury.2021.11.034. Epub 2021 Nov 18.
Fixation of distal femoral fractures is often challenging due to the fracture configuration and associated poor bone quality. Dual plating (lateral and medial) has become an acceptable option to provide improved stability versus a single plate fixation. Though there are several commercially available anatomically designed plates for the lateral femoral condyle, there is no anatomic plate available in UK specifically for medial fixation of distal femur fractures. Our aim is to determine the best suited pre-contoured plate for stabilising the medial femoral condyle (MFC). Right sided femur sawbones were used to determine how well 18 different pre-contoured anatomical plates (Depuy Synthes, Leeds, UK) fit the medial femoral condyle. Some of these had variable angle (VA) option. Lift off, fit and notch penetration were assessed and recorded independently by 4 orthopaedic trauma surgeons. The number and distribution of screws in the MFC that each plate allowed was also determined. To do this the MFC was divided into quadrants: Proximal anterior (PA), distal anterior (DA), proximal posterior (PP) and distal posterior (DP). The ipsilateral anterolateral proximal tibial (VA and 4.5 mm non-VA), PHILOS, posteromedial proximal tibial and ipsilateral lateral extra-articular distal humeral plate offered good sagittal fit, less than 2 mm lift off at the condyles and no diaphyseal lift off. Plate positioning in the PA quadrant offered the best fit. The ipsilateral anterolateral proximal tibial plates (VA) and PHILOS allowed at least 4 screws to be placed in the PA and 2 in the PP quadrant with no notch penetration. The Tomofix provided good fit, but all 4 screws were in PA quadrant, with distal screws causing notch penetration. The non-VA and PHILOS plates did not offer the VA advantage. The ipsilateral anterolateral proximal tibial VA plates provided the best anatomical fit for the MFC with the greatest number of screws in the condylar quadrants with the option of variable angle screw placement.
由于骨折形态和相关的骨质量差，股骨远端骨折的固定常常具有挑战性。双钢板（外侧和内侧）已成为一种可接受的选择，可以提供比单钢板固定更好的稳定性。尽管有几种市售的解剖设计的外侧股骨髁钢板，但英国没有专门用于股骨远端骨折内侧固定的解剖钢板。我们的目的是确定最适合稳定内侧股骨髁（MFC）的预成型钢板。使用右侧股骨锯骨来确定 18 种不同的预成型解剖钢板（Depuy Synthes，利兹，英国）在多大程度上适合内侧股骨髁。其中一些具有可变角度（VA）选项。独立地由 4 位骨科创伤外科医生评估和记录抬起、贴合和切迹穿透。还确定了每个钢板允许在 MFC 中放置的螺钉数量和分布。为此，将 MFC 分为四个象限：近端前（PA）、远端前（DA）、近端后（PP）和远端后（DP）。同侧前外侧近端胫骨（VA 和 4.5 毫米非 VA）、PHILOS、后内侧近端胫骨和同侧外侧关节外远端肱骨钢板提供了良好的矢状贴合，在髁上的抬起小于 2 毫米，没有骨干抬起。PA 象限中的钢板定位提供了最佳贴合。同侧前外侧近端胫骨 VA 钢板和 PHILOS 允许至少 4 个螺钉放置在 PA 和 PP 象限，没有切迹穿透。Tomofix 提供了良好的贴合，但所有 4 个螺钉都在 PA 象限，远端螺钉造成切迹穿透。非 VA 和 PHILOS 钢板没有提供 VA 优势。同侧前外侧近端胫骨 VA 钢板为 MFC 提供了最佳的解剖贴合，在髁状突象限中具有最多数量的螺钉，并且具有可变角度螺钉放置的选择。
