[The "biological" plate osteosynthesis in multi-fragment fractures of the para-articular femur. A prospective study].

In a prospective study, 24 fractures of the femur were treated by indirect reduction and internal fixation with a condylar plate or a condylar buttress plate. The inclusion criterion was that each patients's fracture(s) should be amenable to indirect reduction. The goal of the study was to determine the value of biological plating techniques incorporating the use of the distractor and the articulating tension device for indirect reduction, bridging of the fracture zone without dissection of the medial cortex, and calculated instability through undetermined axial compression. Most fractures were comminuted (5 type A, 10 type B and 9 type C according to the AO classification); 14 fractures were subtrochanteric, 8 fractures were supra-/intracondylar and 2 were diaphyseal in nature. The average age of the 14 mean and 10 women was 46 years (16-96). In 4 cases the fracture was open; 8 patients had multiple trauma and 6 had further ipsilateral fractures. The fractures were sustained in motor vehicle accidents in 14 cases. In 16 fractures operative treatment was performed within 36 h. All fractures were reduced indirectly, and 21 fractures were put under axial compression. There was no medial cortex dissection and no primary bone grafting. Secondary bone grafting was necessary in 2 patients, while 1 (diaphyseal fracture) had delayed bone union and required interlocking nailing. In 2 patients varus deformities under 10 degrees were present after completion of bone healing. There were no refractures and no implant failures. Full weight-bearing commenced at 14.7 weeks. Bone healing time was 18.7 weeks in the 19 patients followed up.(ABSTRACT TRUNCATED AT 250 WORDS)