Vol 4 | Issue 1 | Jan - Apr 2016 | page: 31-36 | Bipul Borthakur[1], Birseek Hanse[2], Russel Haque[3], Saurabh Jindal[4], Manabjyoti Talukdar[5].

Author: Bipul Borthakur[1], Birseek Hanse[2], Russel Haque[3], Saurabh Jindal[4], Manabjyoti Talukdar[5].

[1] Department of Orthopaedics, Assam Medical College, Barbari, Dibrugarh,  PIN - 786 002, Assam, India.
Institute Where Research Was Conducted: Assam Medical College, Dibrugarh, Assam.
University Affiliation: Srimanta Sankaradeva University of Health Sciences, Guwahati.
Year Of Acceptance Of Thesis: 2013.

Address of Correspondence
Dr. Russel Haque
Department of Orthopaedics, Assam Medical College, Barbari, Dibrugarh,
PIN - 786 002, Assam, India.
Email- russelhaq@gmail.com

 Abstract

Background: Distal femoral fractures represents a challenging problem in orthopaedic practice. Open reduction with Internal fixation replaces previous trend of closed conservative management and external fixation. Distal femoral locking compression plate (DF-LCP) requires both locking and compression screw fixation of the femur shaft. This study was conducted to examine the short-term results, early complications and healing rate of distal femoral fractures treated with the DF-LCP.
Materials and Method: 32 patients were included in the study. Lateral approach was performed as standard surgical technique. Functional results evaluated using knee society score.
Results: There were 24 males and 8 female patients of mean age 48.84 years. Road traffic Accident (59.38%) was the commonest mode of injury and 33A3 was the commonest fracture type (25%). Most were closed fractures (78.12%). Late complications seen in 4 cases of implant failure (broken plate and screw breakage) and 2 wound infections. 100% union rate seen with an average union time 14.40 weeks. Knee society score was Excellent in 13 (40.63%), good in 17 (53.12%) and failure in 2 (6.25 %) patients.
Conclusion: DF-LCP is an important armamentarium in treatment of Distal femur fractures especially when fracture is closed, severely comminuted and in situations of osteoporosis.

Introduction

The incidence of distal femoral fractures is 4-7% of all femur fractures. Distal femoral fractures, especially AO Type C fractures are difficult to treat as diastasis of 3 or more millimetres cause Osteoarthritis. The problems associated with conservative management as was done previously are the limitation of reduction and difficulty of maintaining reduction with associated complications of prolonged immobilisation and economic considerations of increased hospital stay. Pin tract infections and joint contractures are common complications with external fixation with devices such as the hybrid external fixator and the Ilizarov external fixator. Internal fixation devices used earlier such as 95° angled blade plate, dynamic condylar screw plate, condylar buttress plate and retrograde supra-condylar inter-locking nail etc. but these implants may not be ideal for complex inter-condylar and metaphyseal comminuted fracture types. Distal femoral locking compression plate (DF-LCP) has a smaller application device and allows both locking and compression screw fixation of the femur shaft. This study was conducted to examine the short term results, early complications and healing rate of distal femoral fractures treated with the distal femoral locking compression plate.

Aim and Objectives
Aim: To study and analyse the results of Locking compression plate (LCP) in Distal Femur Fracture.

Objectives:
1) To Analyse the clinical profile of the patient in regards to age, sex, mode of injury and any other relevant features.
2) To evaluate the Radiological union in treated patients.
3) To evaluate the complications.
4) To evaluate the functional outcome in treated patient based on knee findings.
5) To Assess any factors influencing the results.

Materials And Method
This study was petrformed in Assam Medical College & Hospital, Dibrugarh from July, 2012 to June, 2013 and 32 patients eligible for inclusion were selected who were admitted either through the Outpatient Department (OPD) or the Emergency Department (Casualty). All the fractures were post-traumatic. No pathological fracture was included in the study Patients with distal neurovascular injury is not included in this study. Inclusion Criteria: were Fresh cases of Closed fractures or Type1 open (Gustilo and Anderson) in skeletally mature patients. Exclusion Criteria: were who do not gave consent, unable to take part in post- operative rehabilitation. Open infected wound like Compound fracture(type 2 or 3), Pathological Fractures and Malunited fractures or Long standing cases(>3wks) or patients with Definite major illness like malignancy,chronic major system illness etc. Drug or alcohol abuse were also excluded. After admission into the hospital general and systemic examination as well as local examination along with thorough assessment of patient to rule out other systemic injuries was done followed by evaluation of patients in terms of age ,sex , mode of trauma and period between injury and arrival. Thereafter patient is stabilized with intravenous fluids, oxygen and blood transfusion as and when required. Careful assessment of injured limb as regards to neurovascular status was noted. Primary immobilization done with a Thomas splint and Antero-posterior and true lateral views of injured limb including Hip joint and Knee joint were done. CT scan was done as and when required. Traction given over Thomas splint for complex fractures. Analgesics were administered as required. Preoperative preparation include prophylactic antibiotics (3rd generation cephalosporin) on the evening before surgery and just before skin incision. Either Spinal aneasthesia or General anesthesia were used. Operating field washed with savlon , povidone iodine and was draped separately. PROCEDURE: Lateral approach as standard surgical technique was followed in all patients. The incision should start as proximal as necessary and distally, should extend across the midpoint of the lateral condyle anterior to the fibular collateral ligament, across the knee joint, and then gently curve anteriorly to end distal and lateral to the tibial tubercle. The fascia lata is incised in line with the skin incision. At the knee, the iliotibial tract will need to be incised, and the incision will continue down through the joint capsule and synovium to expose the lateral femoral condyle. The superior geniculate artery will need to be identified and ligated. Care was taken not to incise the lateral meniscus at the lateral joint margin. The vastus lateralis muscle is carefully elevated from the intermuscular septum and is retracted anteriorly and medially. Fractures were reduced under direct vision using manual traction. A knee roll assisted the procurement and maintenance of reduction. The plate length, axial and rotational alignment were checked under image intensifier (IITV).Temporary fixation was achieved through the use of Kirschner- wires. Inter-condylar type fractures were converted to a single condylar block before DF-LCP. Appropriate lengths of the plates were selected intra-operatively. Fixation of plates done. In minimally invasive technique, of selected distal femur fractures,a5-6cm lateral incision limited to the area of the lateral condyle and distal metaphysis was used. The incision was placed more distal to allow for retrograde sub-muscular plate insertion. Condylar screws are placed through the incision used for plate insertion. Adequate length of LCP was taken and placed on distal femur and temporarily fixed with k-wires. Locking compression screws were applied sequentially, followed by proximal screws. Reduction was viewed under IITV. Wound was washed thoroughly with normal saline. Drain was given to every patient. Closure was done in layers after Haemostasis was achieved, followed by Dressing. Posterior plaster slab above knee was applied. Considering the patient's condition and the stability of the internal fixation, mobilization using a walker was done as soon as possible with the help of supervised physiotherapy. Crutch walking given but weight bearing was not allowed. . In case of unstable fracture immobilization was upto 3 weeks. Weight bearing was allowed only after clinical and functional assessment. Patients were followed up clinically at 2, 6, 12 and 24 weeks and radiologically at 6,12 and 24 weeks. Further radiological assessment was done at 6 weeks,3 months, 6 months and 12 months.

Results
Among 32 patients the mean age was 48.84 years ( youngest 18 years and oldest 78 years ), 24 males and 8 females were among the subjects. Slight preponderance of Left side was noted. Road traffic Accident (RTA) (59.38%) was the Commonest mode of injury. Five cases had fractures in other parts of the body. One case had Associated head injury with other parts fracture. Most of the patient were closed fracture 25 Patients (78.12%) and 7 patients (21.88%) were open fractures. Majority (87.50%) were operated in 8–14 days following injury. There were no intraoperative and immediate post-operative complications. Late complications encountered were 2 cases of implant failure (broken locking plate and screw breakage) and 2 wound infections. Broken implants were safely removed and treated with other method. The union rate was 100% in the study group with average union rate 14.40 weeks, with no delayed or non-unions in the study, except 2 failure case treated with other implants. The union rate was 100% in our study group with average union time of 14.40 weeks, with no delayed or non-unions in the study, except 2 failure case treated with other implants. Based on the assessment criteria of knee society score for the present study, the final outcome for all cases was Excellent in 13 (40.63%) patients, good in 17 (53.12%) patients and failure in 2 (6.25 %).

Conclusion
The final outcome of the study based on the assessment criteria of knee society score was Excellent in 13 (40.63%) patients, good in 17 (53.12%) patients and failure in 2 (6.25 %). Thus, Locking Compression Plate is an important armamentarium in treatment of the Distal femur fractures especially when fracture is closed, severely comminuted and in situations of osteoporosis. Further study in large number of patients is required to comment regarding disadvantages and complications.

References
1. Arneson TJ, Melton LJ, Lewallen DG et al Epidemiology of diaphyseal and distal femoral fracture in Rochester, Minnesote 1965, 1984 in orthop Relet res 1988; 234: 188–194.
2. Schatzker J, Lambert DC. Supracondylar Fractures of the Femur. Clin Orthop 1979; 138: 77–83.
3. Kregor PJ, Stannard J, Zlowodzki M, Cole PA, Alonso J. Distal femoral fracture fixation utilizing the Less Invasive StabilizationSystem (L.I.S.S.): The technique and early results. Injury 2001; 32: SC 32–47.
4. Schutz M, Muller M, Krettek C, et al. Minimally invasive fracture stabilization of distal femoral fractures with the LISS: A prospective multicenter study. Results of a clinical study with special emphasis on difficult cases. Injury 2001; 3 2: SC 48–54.
5. Schutz M, Muller M, Regazzoni P, et al. Use of the Less Invasive Stabilization System (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orthop Trauma Surg 2005; 125(2): 102–8.
6. Schandelmaier P, Partenheimer A, Koenemann B, Grun OA, Krettek C. Distal Femoral Fractures and LISS Stabilization. Injury 2001; 32: SC 55–63.
7. Frigg R, Appenzeller A, Christensen R, Frenk A, Gilbert S, Schavan R. The development of the distal femur Less Invasive Stabilization System (LISS). Injury 2001; 32: SC 24–31.
8. Button G, Wolinsky P, Hak D. Failure of Less Invasive Stabilization System Plates in the Distal Femur: A Report of Four Cases.J Orthop Trauma 2004; 18(8): 565–700.
9. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval JK. Biomechanics of Locked Plates and Screws. J Orthop Trauma 2004; 18: 488–93
10. Walling AK, Seradge H, Speigel PG. Injuries to the knee ligaments with fractures of the femur. J Bone Joint Surg Am 1982; 64: 1324–1327.
11. Green NE, Allen FL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977; 59: 236–239.
12. Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am 1963; 45: 889–904.
13. Meyers MH, Moore TM, Harvey JP. Traumatic dislocations of the knee joint. J Bone Joint Surg Am 1975; 57: 430–433. (113).
14. Sisto DJ, Warren RF. Complete knee dislocation. Clin Orthop Relat Res 1985; 198: 94–101
15. Bucholz RW, Jones A. Current Concepts Review: Fractures of the Shaft of the Femur. J Bone Joint Surg Am 1991; 73: 1561–66.
16. Chapman MW. The role of intramedullary fixation in open fractures.Clin Orthop 1986; 212: 27ger–verlag
17. Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures: A report of five hundred and twenty cases. J Bone Joint Surg Am 1984; 66: 529–39.
18. Muller ME, Nazarian J, Koch P, Schatzker J: The comprehensive classification of fractures of longbones, Berlin, 1990, Sprin
19. Brett D. Crist, Gregory J. Della Rocca, Yvonne M. Murtha, MD. Treatment of Acute Distal Femur Fractures. Trauma Orthop July 2008; 31(7): 681.
20. Bucholz RW, Heckman JD. Rockwood & Green's Fractures in Adults. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2001.
21. Taylor JC. In: Crenshaw AH, editor. Campbell’s operative orthopaedics. 8th ed. St. Louis: Mosby–Year Book; 1992. P.785–893.
22. Hoppenfeld S, deBoer P. Surgical exposures in orthopaedics: the anatomic approach, 2nd ed. Philadelphia: Lippincott–Raven, 1994.
23. Starr AJ, Jones AL, Reinert CM. The “swashbuckler”: a modified anterior approach for fractures of the distal femur. J Orthop Trauma 1999; 13: 138–140.
24. Farouk O, Krettek C, Miclau T, et al. Effects of percutaneous and conventional plating techniques on the blood supply to the femur. Arch Trauma Surg 1998; 117: 438–441.
25. Krettek C, Schandelmaier P, Miclau T, et al. Transarticular joint reconstruction and indirect plate osteosynthesis for distal supracondylar femoral fractures. Injury 1997; 28: SA31–SA41.
26. Krettek C, Schandelmaier P, Miclau T, et al. Minimally invasive percutaneous plate osteosynthesis (MIPPO) using the DCS in proximal and distal femoral fractures. Injury 1997; 28: SA20–SA30.
27. Sisto DJ, Warren RF. Complete knee dislocation. Clin Orthop Relat Res 1985; 198: 94–10119.
28. Schatzker J. Fractures of the distal femur revisited. Clin Orthop Relat Res 1998; 347: 43–56.
29. Mc Rae R. Practical fracture treatment. 3rd ed. Edinburgh: Churchill Livingstone; 1998.
30. Wagner M. General principles for the clinical use of the LCP. Injury 2003 Nov; 34 Suppl 2: B31–42.
31. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004; 18: 488–93.
32. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br.2002; 84: 1093–110.
33. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the Locking Compression Plate (LCP). Injury. 2003; 34 Suppl 2: B43–54.
34. Schütz M, Südkamp NP. Revolution in plate osteosynthesis: new internal fixator systems. J Orthop Sci. 2003; 8: 252–8.
35. Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP —how can stability in locked internal fixators be controlled?Injury. 2003; 34 Suppl 2: B11–9.
36. Lill H, Hepp P, Rose T, König K, Josten C. [Theangle stable locking–proximal–humerus–plate (LPHP) for proximal humeral fractures using a small anterior–lateral–deltoid–splitting–approach — technique and first results]. Zentralbl Chir. 2004; 129: 43–8.German.
37. Wagner M. General principles for the clinical use of the LCP. Injury. 2003; 34 Suppl 2: B31–42.
38. Gutwald R, Alpert B, Schmelzeisen R. Principle and stability of locking plates. Keio J Med. 2003; 52: 21–4.
39. Niemeyer P, Südkamp NP. Principles and clinical application of the locking compression plate (LCP).Acta Chir Orthop Traumatol Cech. 2006; 73: 221–8.
40. Sommer Ch, Gautier E. [Relevance and advantages of new angular stable screw–plate systems for diaphyseal fractures (locking compression plate versus intramedullary nail)]. Ther Umsch. 2003; 60: 751–6. German.
41. Sommer C. Fixation of transverse fractures of the sternum and sacrum with the locking compression plate system: two case reports. J OrthopTrauma. 2005; 19: 487–90.
42. Wong KK, Chan KW, Kwok TK, Mak KH. Volar fixation of dorsally displaced distal radial fracture using locking compression plate. J Orthop Surg (Hong Kong). 2005; 13: 153–7.
43. Rikli DA, Babst R. [New principles in the surgical treatment of distal radius fractures — locking implants]. Ther Umsch. 2003; 60: 745–50. German.
44. Stahel PF, Infanger M, Bleif IM, Heyde CE, Ertel W. [Palmar angular–stable plate osteosynthesis: a new concept for treatment of unstable distal radius fractures]. Trauma Berufskrankh. 2005; 7 Suppl 1: S27–32. German.
45. Schaller TM, Roehr B. Salvage of a failed opening wedge tibial osteotomy using a locking plate. Orthopedics. 2007; 30: 161–2.
46. Rose PS, Adams CR, Torchia ME, Jacofsky DJ, Haidukewych GG, Steinmann SP.Locking plate fixation for proximal humeral fractures: initial results with a new implant. J Shoulder Elbow Surg. 2007; 16: 202–7.
47. Noelle Larson A, Rizzo M. Locking plate technology and its applications in upper extremity fracture care. Hand Clin. 2007; 23: 269–78.
48. Murakami K, Abe Y, Takahashi K. Surgical treatment of unstable distal radius fractures with volar locking plates. J Orthop Sci. 2007; 12: 13440.
49. Weinraub GM. Midfoot arthrodesis using a locking anterior cervical plate as adjunctive fixation: early experience with a new implant. J Foot AnkleSurg. 2006; 45: 240–3.
50. Gallentine JW, Deorio JK, Deorio MJ. Bunion surgery using locking–plate fixation of proximal metatarsal chevron osteotomies. Foot Ankle Int 2007; 28: 361–8.
51. Sommer C, Babst R, Müller M, Hanson B. Locking compression plate loosening and plate breakage: a report of four cases. J Orthop Trauma.2004; 18: 571–7.
52. Arora R, Lutz M, Hennerbichler A, Krappinger D, Espen D, Gabl M. Complications following internal fixation of unstable distal radius fracture with a palmar locking–plate. J Orthop Trauma. 2007; 21: 316–22.
53. Arora R, Lutz M, Zimmermann R, Krappinger D, Gabl M, Pechlaner S. [Limits of palmar lockingplate osteosynthesis of unstable distal radius fractures]. Handchir Mikrochir Plast Chir. 2007; 39: 34–41. German.
54. Namazi H, Mozaffarian K. Awful considerations with LCP instrumentation: a new pitfall. Arch Orthop Trauma Surg. 2007; 127: 573–5.
55. Phisitkul P, McKinley TO, Nepola JV, Marsh JL. Complications of locking plate fixation in complex proximal tibia injuries. J Orthop Trauma. 2007; 21: 83–91.
56. Gautier E, Sommer C. Guidelines for the clinical application of the LCP. Injury. 2003; 34 Suppl 2: B63–76.
57. Marti A, Fankhauser C, Frenk A, Cordey J, Gasser B. Biomechanical evaluation of the less invasive stabilization system for the internal fixation of distal femur fractures. J Orthop Trauma. 2001; 15(7): 482–487.
58. Goesling T, Frenk A, Appenzeller A, et al. LISS PLT: design, mechanical and biomechanical characteristics. Injury. 2003; 34: A11–A15.
59. Rambold, S. Depressed fractures of the tibial plateau. JBJS 1960; 42A: 783–797.
60. Wade R. Smith, MD, Bruce H. Ziran, MD, Jeff O. Anglen, MD, and Philip F. Stahel, md: locking plates: tips and tricks; the journal of bone & joint surgery jbjs.org volume 89–a number 10 october 2007
61. Lambotte A.chirurgie operatiore des Fractures.Paris, France: Masson editors, 1913.
62. Muller ME, Allogwer M, Schneider R, et al. Manual of internal fixation. Heidelberg Springer, 1991.
63. Baumgaertel F, Dahlen C, Stiletto R, et al. Technique of using AO distractor for Femural IM Nailing. J orthop trauma 1994; 8: 315–321.
64. Greiwe RM, Archdeacon MT. Locking plate technology: current concepts. J Knee Surg. 2007; 20: 50–5.
65. Cantu RV, Koval KJ. The use of locking plates in fracture care. J Am Acad Orthop Surg. 2006; 14: 183–90.
66. Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates andscrews. J Orthop Trauma. 2004; 18: 488–93.
67. Frigg R. Locking Compression Plate (LCP). Anosteosynthesis plate based on the DynamicCompression Plate and the Point Contact Fixator (PC–Fix). Injury. 2001; 32 Suppl 2: 63–6.
68. Frigg R. Development of the Locking Compression Plate. Injury. 2003; 34 Suppl 2: B6–10.
69. Morscher E, Sutter F, Jenny H, Olerud S. [Anterior plating of the cervical spine with the hollow screwplate system of titanium]. Chirurg. 1986; 57: 702–7.German.
70. Arnold W. [Initial clinical experiences with the cervical spine titanium locking plate]. Unfallchirurg.1990; 93: 559–61. German.
71. Söderholm AL, Lindqvist C, Skutnabb K, Rahn B.Bridging of mandibular defects with two different reconstruction systems: an experimental study. J Oral Maxillofac Surg.1991; 49: 1098–105.
72. Miclau T, Remiger A, Tepic S, Lindsey R, McIff T. A mechanical comparison of the dynamic compression plate, limited contact–dynamic compression plate, and point contact fixator. J Orthop Trauma. 1995; 9: 17–22.
73. Kolodziej P, Lee FS, Patel A, Kassab SS, Shen KL, Yang KH, Mast JW. Biomechanical evaluation of the schuhli nut. Clin Orthop Relat Res. 1998; 347: 79–85.
74. Borgeaud M, Cordey J, Leyvraz PE, Perren SM.Mechanical analysis of the bone to plate interface of the LC–DCP and of the PC–FIX on human femora.Injury. 2000; 31 Suppl3: C2936.
75. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br. 2002; 84: 1093–110.
76. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the Locking Compression Plate (LCP). Injury. 2003; 34 Suppl 2: B43–54.
77. Schütz M, Südkamp NP. Revolution in plate osteosynthesis: new internal fixator systems. J Orthop Sci. 2003; 8: 252–8.
78. Wagner M, Frenk A, Frigg R. New concepts for bone fracture treatment and the Locking Compression Plate. Surg Technol Int. 2004; 12: 271–7.
79. Bucholz RW, Jones A. Current Concepts Review: Fractures of the Shaft of the Femur. J Bone Joint Surg Am 1991; 73: 1561–66.
80. M.S. Butt, S.J. Krikler, M.S. Ali; Displaced Fractures of the Distal femur in elderly patients: open versus non–operative treatment: (J Bone Joint Surg [Br] 1995; 77–B: 110–4)
81. Bolhofner, Brett R.; Carmen, Barbara; Clifford, Philip; The Results of Open Reduction and Internal Fixation of Distal Femur Fractures Using a Biologic (Indirect) ReductionTechnique; J Orthop Trauma, Volume 10(6), August 1996, pp 372–377
82. David R, Jesse BJ, Richard AS, Jaime Q, Vincent MS, Reinhold G, Rene K. Multiple complex nonunion of fractures of the femoral shaft treated by wave–plate osteosynthesis. J Bone Joint Surg Br 1997; 79–B: 289–94.
83. Michael WC, Christopher GF, Sacramento C. Treatment of Supracondylar Nonunions of the Femur with Plate Fixation and Bone Graft. J Bone Joint Surg Am 1999; 81: 1217–28.
84. Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002 Nov; 84(8): 1093–110.
85. Frankie L, Xiang Z. Locking compression plate fixation for periprosthetic femoral fracture. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2002 Mar; 16 (2): 123–5.
86. A Saw, CP Lau: Supracondylar nailing for difficult distal femur fractures; (Journal of Orthopaedic Surgery 2003: 11(2): 141–147
87. Philip J. Kregor, MD, James A. Stannard, MD, Michael Zlowodzki, MD, and Peter A. Cole, MD: Treatment of Distal Femur Fractures Using the Less Invasive Stabilization System Surgical Experience and Early Clinical Results in 103 Fractures; (J Orthop Trauma 2004; 18: 509–520)
88. Bellabarba C, Ricci WM, Bolhofner BR. Indirect Reduction and Plating of Distal Femoral Nonunions. J Orthop Trauma: 2002 May; 16(5): 287–96.
89. Wagner M. General principles for the clinical use of the LCP. Injury 2003 Nov; 34 Suppl 2: B31–42.
90. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M. First clinical results of the Locking Compression Plate (LCP). Injury 2003 Nov; 34 Suppl 2: B43–54.
91. Rosa MFTD, Tenorio EC Jr. Treatment of Comminuted Femoral Shaft Fractures Using Minimally Invasive Plate Osteosynthesis in a Delayed Setting. Techniques in Orthopaedics 2006 Jun; 21(2): 99–108.
92. Yeap EJ, Deepak AS. Distal Femoral Locking Compression Plate Fixation in Distal Femoral Fractures: Early Results. Malaysian Orthopaedic Journal 2007May; 1(1): 12–17.
93. Yolanda HG, Andrés DM, Fernando JS, Carlos RE, Early results with the new internal fixator systems LCP and LISS: A prospective study. Acta Orthop Belg 2007; 73: 60–69
94. Wade RS, Bruce HZ, Jeff OA, Philip FS. Locking Plates: Tips and Tricks. J Bone Joint Surg Am. 2007; 89: 2298–2307.
95. Thomas Mückley, MD1, Dirk Wähnert, MD1, Konrad L. Hoffmeier, Dipl–Ing1, Geert von Oldenburg, Dipl–Ing2, Rosemarie Fröber, MD3 and Gunther O. Hofmann, MD, Dr rer nat1: Internal Fixation of Type–C Distal Femoral Fractures in Osteoporotic Bon (JBJS Vol. 92–A, pp. 1442–52, June 2010).
96. Trevor J. Lujan, PhD, Chris E. Henderson, MD, Steven M. Madey, MD, Dan C.Fitzpatrick, MD, J. Lawrence Marsh, MD, and Michael Bottlang, PhD: Locked Plating of Distal Femur Fractures Leads to Inconsistent and Asymmetric Callus Formation. (J Orthop Trauma 2010; 24: 156–162).
97. Kanabar P, Kumar V, Owen PJ. Less invasive stabilisation system plating for distal femoral fractures. J Orthop Surg 2007 Dec; 15(3): 299–302.
98. Ru J, Hu Y, Liu F.Treatment of distal femur fracture by less invasive stabilization system–distal femur.Chinese journal of reparative and reconstructive Surgery. Dec 2007; 21(12): 1290–4.
99. Hedequist D, Bishop J, Hresko T. Locking plate fixation for pediatric femur fractures.J Pediatr Orthop 2008 Jan–Feb; 28(1): 6–9.
100. Paul Baker, Ian Mcmurtry, Andrew Port. The treatment of distal femoral fractures in children using the LISS plate: a report of two cases. Ann R Coll Surg Engl 2008; 90.
101. Ehlinger M, Cognet JM, Simon P.Treatment of femoral fracture on previous implants with minimally–invasive surgery and total weight–bearing: Benefit of locking plate. Preliminary report. Rev Chir Orthop Reparatrice Appar Mot 2008 Feb; 94(1): 26–36.
102. Yu X, Zhang C, Li X, Shi Z.Treatment evaluation of distal femoral fractureby less invasive stabilization system via two incisions. Chinese journal ofreparative and reconstructive Surgery.May 2008; 22 (5): 520–3.
103. JPS Walia, Avinash Gupta, Girish Sahni, Gagandeep Gupta, Sonam Kaur Walia Role of locking compression plate in long bone fractures in adults – a study of 50 cases. Pb Journal of Orthopaedics Vol–XI, No.1, 2009.
104. Bae SH, Cha SH, Suh JT.Treatment of Femur Supracondylar Fracture with Locking Compression Plate. Jn Korean Fract Soc. Jul 2010; 23(3): 282–88.
105. EL Ganainy, Abdel Rahman Adham ELGEIDI Treatment of distal femoral fractures in elderly diabetic patients using minimally invasive percutaneous plating osteosynthesis (MIPPO) Acta Orthop. Belg., 2010, 76, 503–506
106. Joseph L C, A M Singh, S Waikhom. Interlocking nailing of fracture of distal shaft of femur. JMS: May 2011; 26 (2): 24–28.
107. Ravi M Nayak, MR Koichade, Alok N Umre, Milind V Ingle: Minimally invasive plate osteosynthesis using a locking compression plate for distal femoral fractures; (Journal of Orthopaedic Surgery 2011; 19(2): 185–90).
108. Manohar et al: Functional outcome following ORIF of supracondylar intercondylar fracture Femur; (Kerala Journal ofOrthopaedics2012; 25: 1–5).
109. Supanich V, MD: Results of the Treatment of Type–C Distal Femoral Fractures using Four Different Implants: Condylar Blade Plate, Dynamic Condylar Screw, Condylar Buttress Plate, and Distal Femoral Locking Plate; (JRCOST VOL.36 NO.1–2 January–April 2012.
110. Michael Schütz and Norbert P. Südkamp. Instructional lectures. Revolution in plate osteosynthesis: new internal fixator systems. Journal of Orthopaedic Science Volume 8, Number 2, 252–58.
111. JB Giles, JC DeLee, JD Heckman and JE Keever. Supracondylar– Intercondylar fractures of the femur treated with a supracondylar Plate and lag screw. J Bone Joint Surg Am. 1.
112. Glassner, Philip J MD; Tejwani, Nirmal C MD. Failure of Proximal Femoral Locking Compression Plate: A Case Series. Journal of Orthopaedic Trauma: February 2011; 25 (2): 76–83.
113. Joseph L C, A M Singh, S Waikhom. Interlocking nailing of fracture of distal shaft of femur.JMS: May 2011; 26 (2): 24–28.
114. Su Qi, Chen Mountain, Zhang flowers, Zhou, Song Xiaobin, Zhanhai Peng, Cai Jundong.Locking compression plate fixation of distal femoral fracturesC.Clinical Medicine Papers.http: //www.hi138.com /access on10.5.2011.
115. Valles Figueroa JFJ, Rodríguez Reséndiz F, Gómez Mont JG.Distal femur fractures.Comparative analysis of two different surgical treatments. Acta Ortopédica Mexicana 2010; 24(5): 323–29.
116. Mongkon Luechoowong. The Locking Compression Plate (LCP) for Distal Femoral Fractures. Buddhachinaraj Medical Journal Volume 25 (Supplement 1) January–April 2008.
117. Weight M, Collinge C.Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma. 2004 Sep; 18 (8): 503–8.
118. Zhang CQ, Cheng XG, Sheng JG, Li HS, Su Y, Xu J, Zeng BF. The surgical technique and follow–up of the treatment with locking internal fixation on long bone nonunion of extremities. Zhonghua Wai Ke Za Zhi 2008 Apr 1; 46(7): 510–3.
119. Sanders R, Swiontkowski M, Rosen H, Helfet D. Double–plating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg Am. 1991; 73: 341–46.
120. Bostman O, Varjonen L, Vainionpaa AS.Incidence of local complications after intra medullary nailing and after plate fixation of femoral shaft fractures. J Trauma 1989; 29: 639–45
121. Gustilo RB, Merkow RL, Templeman D. Current Concepts Review: The management of open fractures. J Bone Joint Surg Am 1990; 72: 299–304fractures of longbones, Berlin, 1990, Sprin.
122. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989 Nov; (248): 13–4. link to pubmed
123. Asif S, Choon DS midterm result of cemented prees fit condylar sigma total knee arthroplasty system J orthop surg (Hong Kong).2005dec; 13(3): 280–419.

Download Full Text PDF   |  Download Full Thesis