الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Distal femur fractures are relatively common injuries. The goal of treatment is to achieve anatomic reduction of the articular surface, restoration of limb alignment, length, and rotation.
Fracture Healing is greatly influenced by the fixation method. Classic compression plate fixation requires the creation of a rigid plate/bone construct which involves soft tissue stripping and devitalization of the underlying bone, this may lead to inhibited callus formation. Hence, the concept of bridge plating with minimal soft tissue stripping using locking plates has been promoted.
The benefits of locked plating, including improved fixation strength in osteoporotic bone and the ability to provide a more biologically friendly fixation construct, have led to the rapid adoption of this technology. Recent studies quote nonunion or fixation failure rates after locked plating of distal femur fractures of 10%–23%. The rigidity at the fracture site is believed to be responsible for delayed callus formation, leading to reported delayed unions or nonunions
The concept of “Dynamic” locked Plates has been proposed to decrease construct stiffness and improve callus formation. Near-cortical over-drilling technique has been proposed and is based on the same biomechanical concept of dynamic locked plating but uses standard locking plates instead of a specially designed implant.
The aim of this study was to compare functional and radiological outcomes in lower femur fractures treated by DLP (using near cortical over drilling) to that treated by SLP.
Through the period from May 2020 to January 2023 this prospective randomized study was conducted. Thirty patients with distal femoral fractures were enrolled in the study, age ranging between 18 and 65 years and they were divided into 2 equal groups; group A (DLP): 15 patients treated with dynamic locked plating (using near cortical over drilling), and group B (SLP): 15 patients treated with standard locked plating. Patients were followed up for 1 year postoperatively.
In DLP group, the mean time of fracture union was 13.3 weeks with a range of 10 to 24 weeks. Out of 15 cases; one case (6.7%) had delayed union, while one case (6.7%) developed nonunion, while, in SLP group the mean time of fracture union was 16.3 weeks, with a range of 12 to 32 weeks. three cases (20%) had delayed union with one cases of nonunion (6.7%).
The mean callus score for the DLP group was significantly higher (1.9) compared to that in DLP group (1.0), (p value = 0.015).
The mean ROM was 116.40 of knee flexion in DLP group, while in SLP group mean ROM was 114.60 of knee flexion.
Two patients (13.3%) in DLP group developed complications, while five patients (33.3%) in SLP group had complications.
The current study demonstrated no statistically significant differences in nonunion rate, or other specific complications between both groups. However, the DLP group was noted to have statistically significant higher callus scores at six weeks postoperative indicating increased fracture callus formation. Although, time of union showed no statistical significance between both groups, it was still shorter in the DLP group.
DLP seems to result in improved callus formation and bone healing without sacrificing fixation strength compared with SLP when used for fractures of the distal femur.
Limitations to this study included; the relatively small number of patients together with short term follow-up, In addition to subjective and observer dependent callus scoring. We recommend further larger trials with larger number of cases and longer follow up periods to fully evaluate this method.