title: Minimally-invasive fixation of distal extra-articular femur fractures with locking plates: limitations and failures.
abstract: Minimally-invasive fixation using a locking plate and early motion is normal practice. However, technical errors and pitfalls are common. This surgery has a set of rules that encompass both the mechanics of the internal fixation system and the implantation itself. If these rules are not strictly followed, alignment defects and/or early failure of the fixation can occur. We analysed four cases of clinical failure that were encountered after minimally-invasive distal femoral extra-articular fixation with locking plates. The following rules must be followed with this technique: extra-articular fracture, minimally-invasive approach, long plate alternating between locking screw and empty hole (five holes on either side of fracture), bi-cortical screws, placement of locking screws near a complex fracture but away from a simple fracture. Osteoporotic bone, obesity that interferes with the instrumentation, articular fracture, horizontal fracture line and surgeon experience are all limitations of this minimally-invasive technique.
authors.affiliation: Orthopaedic Surgery and Traumatology Department, Hautepierre Hospital, Strasbourg University Hospitals, 1, avenue Molière, 67098 Strasbourg cedex, France. matthieu.ehlinger@chru-strasbourg.fr
authors.forename: M
authors.initials: M
authors.lastname: Ehlinger
authors.forename: P
authors.initials: P
authors.lastname: Adam
authors.forename: Y
authors.initials: Y
authors.lastname: Arlettaz
authors.forename: B K
authors.initials: BK
authors.lastname: Moor
authors.forename: A
authors.initials: A
authors.lastname: DiMarco
authors.forename: D
authors.initials: D
authors.lastname: Brinkert
authors.forename: F
authors.initials: F
authors.lastname: Bonnomet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001860:Bone Plates; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D017211:Treatment Failure