Dynamic Locked Plating Using Near-Cortical Over-Drilling versus Standard Locked Plating for Fixation of Lower Femur Fractures

Abstract Background Fracture Healing in distal femoral fractures is greatly influenced by fixation method. Classic compression plate requires creation of a rigid plate/bone construct which involves soft-tissue stripping and devitalization of the underlying bone, this may lead to inhibited callus formation. Hence, the concept of “Dynamic” Locked Plates has been proposed to decrease construct stiffness and improve callus formation. Aim of the Work To compare functional and radiological outcomes in lower femur fractures treated by dynamic locked plating (using near cortical over drilling) to that treated by standard locked plating. Patients and Methods Prospective study was conducted starting from May 2020 to January 2023 including 30 patients aged from 18 to 65 years old with distal femur fracture treated by dynamic locked plating with near cortex over drilling (15 patients) or standard locked plating (15 patients). We excluded patients with open fractures, periprosthetic fractures, floating knee injuries and poly-traumatized patients. The follow up period was 1 year. Results The current study demonstrated no statistically significant difference between both groups regarding time of union, knee range of motion, nonunion rate, or other specific complications. However, the DLP group was noted to have statistically significant higher callus scores at six weeks postoperative (p value = 0.015) indicating increased callus formation. Conclusion Dynamic locked plating seems to result in improved callus formation and bone healing without sacrificing fixation strength compared with traditional locked plating when used for fractures of the distal femur.