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Low energy fractures: what is the difference? specific features and clinical outcomes by minimally invasive locking plates

Je-hyun Yoo, Seok-woo Kim, Yoon-hae Kwak, Hong-kyun Kim, Ji-hyo Hwang, Jung-uk Kim, Sung-in Hong

Hypothesis: We hypothesized a locking compression plate was in favor of the treatment of high energy related fracture. Low energy fracture can obtain different outcomes by minimally invasive locked plating. We predict the different clinical features and outcomes compared with previous osteoporosis patients group.

Methods: 34 patients with low-energy distal femoral fractures (mean age 69.6 years) treated with minimally invasive locked plating were enrolled. Fracture pattern at trauma, clinical and radiological evaluations during the follow-up period were analyzed. All patients were followed for a minimum of 12 months postoperatively.

Results: The majority of fractures (76.3%) were extraarticular type and the comminuted fracture configuration was in 19 patients (55.8%), biomechanical fracture pattern was spiral in 10 patients (71.4%) among 14 linear fractures. The mean time to union was 19.1 weeks (range 14-30). Eight patients (23.5%) were shown as delayed union. Four patients (11.7%) developed implant failure. The mean knee range of motion was 116.7 degrees (range 50-140) and the Oxford knee scores averaged 34.4 (range 16-48).

Conclusion: Low energy fracture showed extraarticular communited fracture and noncommunited linear fracture was spiral which looks simple. But the minimally invasive locked plating in these group result in significant delayed union and metal failure. The use of low screw density in the proximal fragment, long plates, a proximal uppermost cortical screw can lower the risk of implant failure in the low energy fractures.