Biomechanical and clinical comparison of single lateral plate and double plating of comminuted supracondylar femoral fractures

Abstract

This study was to compare the relative strength of fixation and clinical outcomes of single lateral plate and double plating of comminuted supracondylar femoral fractures.

Eight matched pairs of embalmed cadaveric femurs were selected. A gap osteotomy was created to stimulate an AO/OTA A3 comminuted distal femoral fracture. One femur of each pair was fixed with a locking plate; the other, with a locking plate and a medial plate. Nondestructive axial compression and maximum load to failure test were performed. A total of 32 patients with comminuted supracondylar femoral fractures were identified and divided into single lateral plate group (SPG) and double plating group (DPG) randomly. Operative time, blood loss, time to union and complications were recorded. Visual analog score (VAS), range of motion (ROM) and Neer knee score were reviewed at one, three, 6, and 12 months postoperatively.

Significantly greater axial displacement occurred with the SPG than with the DPG. In load-to-failure testing, the peak load was 2568 ± 452 N, and 3822 ± 567 N, respectively. The follow-ups lasted twelve months at least. The operative time was significantly lower in the SPG. However, there was no significant difference between the SPG and the DPG in terms of blood loss, time to union, complication rate, VAS, ROM and Neer knee score.

Double plating proved stronger than single lateral plate in biomechanical testing; however, double plating was not superior to traditional lateral plating in clinical outcomes. Therefore, we do not recommend double plating as a routine fixation of comminuted supracondylar femoral fractures.