A. Madhusudhana1, Narendra Avalapati2, M. Rajesh3
Incidence of distal femur fractures is approximately 37 per 1,00,000 person-years.¹Distal femoral fractures has two different injury mechanisms, high energy trauma and low energy trauma. In high-energy trauma, the problem of restoring the function in a destroyed knee joint persists. Complex knee ligament injuries frequently occur additionally to extensive cartilage injuries. In elderly patients, extreme osteoporosis represents a particular problem for anchoring the implant.2 Supracondylar and inter condylar fractures often are unstable and comminuted and tend to occur in the elderly or those with multiple injuries. Treatment options are many with varied results. The final outcome would depend upon the type of fracture, stabilization of fixation and and perhaps patient general condition.3The options for operative treatment are traditional plating techniques that require compression of the implant to the femoral shaft (blade plate, Dynamic Condylar Screw, non-locking condylar buttress plate), antegrade nailing fixation, retrograde nailing, sub muscular locked internal fixation and external fixation.4 However, as the complexity of fractures needing treatment has changed from simple extra-articular supra-condylar types to inter-condylar and metaphyseal comminuted types, these implants may not be ideal. Double plating, and more recently, locked plating techniques have been advocated5. However with double plating there is often extensive soft tissue stripping on both sides of the femur, resulting in reduced blood supply and potential non-union and failure of the implants6. The LCP is a single beam construct where the strength of its fixation is equal to the sum of all screw-bone interfaces rather than a single screw’s axial stiffness or pullout resistance as seen in unlocked plates7,8. Its unique biomechanical function is based on splinting rather than compression resulting in flexible stabilization, avoidance of stress shielding and induction of callus formation. Further when it is applied via a minimally invasive technique, it allows for prompt healing, lower rates of infection and reduced bone resorption as blood supply is preserved.9,10 The implant offers multiple points of fixed-angle contact between the plate and screws in the distal part of femur, theoretically reducing the tendency for varus collapse that is seen with traditional lateral plates.10
