[Technique of plate osteosynthesis of the femur]

When plating is performed for fixation of complex femoral fractures the need for medial buttress to give durable weight-bearing ability of the bone is mandatory. However the means of achieving this is controversial. Many authors are in favour of mechanical reconstruction of the medial buttress, if necessary with a bone graft. Alternatively, medial buttress can be achieved by means of a technique allowing biological fracture healing, which is only possible, when the vascularity of all fragments is preserved. In 39 cases of osteosynthesis with plates for complex femoral fractures the bridging technique was used at surgery, to avoid denudation of the fragments. All osteosyntheses were performed without the application of bone clamps. After minimal exposure of the femur at the lateral side only, the plates were fixed in the main proximal fragment with one screw, in the case of blade plates the blade was fixed without bone clamps too. Afterwards the main distal fragment was drawn up to the plate and fixed directly and with a screw. In 9 cases the plates were inserted behind the vastus lateralis muscle, preserving its continuity, and fixed distally with another screw. After fine checking of the fracture alignment for rotation and length the plates were fixed with four or five screws in each main fragment, all at sites distant from the fracture. Meanwhile, all 39 fractures have consolidated. There were no cases of infection. Bone grafting was necessary in 8 cases. Only in 2 cases were the defects located in the medial area. In 37 of the 39 osteosyntheses an excellent medial buttress was achieved by bone healing.(ABSTRACT TRUNCATED AT 250 WORDS)