Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation

Christopher E Henderson; Trevor Lujan; Michael Bottlang; Daniel C Fitzpatrick; Steve M Madey; J Lawrence Marsh

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$Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation$

Journal article

Open access

Peer reviewed

Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation

Christopher E Henderson, Trevor Lujan, Michael Bottlang, Daniel C Fitzpatrick, Steve M Madey and J Lawrence Marsh

The Iowa orthopaedic journal, Vol.30, pp.61-68

2010

PMCID: PMC2958272

PMID: 21045973

Appears in Diamond Open Access

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958272/View

Published (Version of record) Open Access

Abstract

This study compared callus formation in distal femur fractures stabilized with locking plates and intramedullary nails to test the hypothesis that locking plates induce less fracture callus than IM nails. Retrospective case matched study. Two orthopaedic trauma centers. 174 distal femur fracture were reviewed to extract cases treated with retrograde IM nails (NAIL group, n = 12). These were then individually matched to cases treated with locking plates (Plate group, n = 12). Retrograde IM nailing or locking plate fracture fixation. Periosteal callus was measured on lateral and antero-posterior radiographs taken at 12 weeks after injury using validated software to objectively extract the size of peripheral callus from digital radiographs. The NAIL group had 2.4 times more callus area per location (231 ± 304 mm(2)) than the PLATE group (95 ± 109 mm(2), p=0.028). Compared to the PLATE group, the NAIL group had 3.4 times more callus anteriorly (p=0.31), 2.6 times more callus posteriorly (p=0.25), and 2.3 times more callus medially (p=0.16). At 12 weeks after injury, no or minimal callus for secondary bone healing (<20 mm(2)) was present in 20% of callus locations in the NAIL group and in 54% of callus locations in the PLATE group. Significantly less periosteal callus formed in fractures stabilized with locking plates than with IM nails. This result is likely multifactorial and further study of the interaction between construct stiffness and fracture healing in the distal femur is warranted.

Radiography

Prevalence

Bone Nails

Follow-Up Studies

Outcome Assessment (Health Care)

Humans

Middle Aged

Orthopedic Procedures - methods

Fracture Fixation, Internal - methods

Male

Femur - diagnostic imaging

Bone Plates

Bony Callus - diagnostic imaging

Aged, 80 and over

Fracture Healing - physiology

Adult

Female

Femur - surgery

Retrospective Studies

Fractures, Bone - diagnostic imaging

Femur - injuries

Treatment Outcome

Fractures, Bone - surgery

Orthopedic Procedures - instrumentation

Fracture Fixation, Internal - instrumentation

Fractures, Bone - physiopathology

Aged

Bony Callus - physiopathology

Details

Title: Subtitle: Stabilization of distal femur fractures with intramedullary nails and locking plates: differences in callus formation
Creators: Christopher E Henderson - Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, IA 52242, USA
Trevor Lujan
Michael Bottlang
Daniel C Fitzpatrick
Steve M Madey
J Lawrence Marsh
Resource Type: Journal article
Publication Details: The Iowa orthopaedic journal, Vol.30, pp.61-68
Publisher: Dept. of Orthopaedics, The University of Iowa; United States
PMID: 21045973
PMCID: PMC2958272
ISSN: 1541-5457
eISSN: 1555-1377
Language: English
Date published: 2010
Academic Unit: Orthopedics and Rehabilitation
Record Identifier: 9984040330902771

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