Dual-Plating in Distal Femur Fracture: A Systematic Review and Limited Meta-analysis

Area of Science:

• Orthopedic surgery
• Traumatology
• Biomechanical engineering

Background:

• Distal femur fractures, especially comminuted metaphyseal and articular types, present challenges with high rates of varus collapse and implant failure using standard lateral locking plates.
• Dual plating has emerged as a potential alternative for managing these complex fractures, aiming to improve stability and reduce complications.

Purpose of the Study:

• To systematically review and evaluate the functional outcomes and complication rates associated with dual plating versus single plating for distal femur fractures.
• To compare the efficacy and safety of dual plating techniques in managing comminuted distal femur fractures.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials).
• 12 studies, including one randomized-controlled trial, four prospective, and seven retrospective studies, involving 292 knees (213 dual plating, 76 single plating), were included in the analysis.
• Outcomes assessed included union rates, healing time, functional scores (VAS, Neer, Kolmert), surgical duration, and blood loss.

Main Results:

• Dual plating demonstrated faster fracture healing (mean difference 5.43 weeks, p=0.0002) but involved a longer surgical duration (mean difference -16.84 minutes, p=0.0001).
• Nonunion and delayed union rates for dual plating were up to 12.5% and 33.3%, respectively; pooled analysis showed no significant difference in nonunion rates compared to single plating (9.2% vs. 0%, p=0.13).
• Functional outcomes (VAS, Neer, Kolmert scores) and complication rates, including blood loss, showed no significant difference between single and dual plating techniques.

Conclusions:

• Dual plating provides satisfactory union for comminuted metaphyseal and articular distal femur fractures.
• While dual fixation accelerates fracture healing, it increases surgical time without significantly improving functional outcomes or reducing complications compared to single plating.
• The choice between single and dual plating should consider the trade-off between faster healing and increased surgical complexity.