[Minimally invasive plate osteosynthesis of the distal femur].

OBJECTIVE: Minimally invasive stabilization of articular and extra-articular fractures of the distal femur with anatomically preshaped, locking compression plates.

INDICATIONS: Distal extra-articular femoral fractures. Distal periprosthetic or periosteosynthetic femoral fractures. Multifragmentary articular fractures of the distal femur.

CONTRAINDICATIONS: Local soft tissue infection or osteitis.

SURGICAL TECHNIQUE: Patient in a supine position on a radiolucent table with both legs draped free. Fractured leg supported with a towel to release traction of the gastrocnemius muscles onto the distal fragment. Reduction and fixation of articular fractures with 3.5 mm lag screws. Indirect reduction of the metaphyseal fracture component and temporary fixation with different instruments (e.g. cerclage) or reduction to the plate with special tools (e.g. collinear reduction clamp). Submuscular epiperiosteal introduction of the plate. Plate fixation through the aiming device. Intraoperative image intensification control to check plate position and reduction with special emphasis on rotation and longitudinal axes.

POSTOPERATIVE MANAGEMENT: Continuous passive motion without range limitations from day 1. Mobilization on crutches with toe-to-tip weight bearing during the first 6 weeks. No full weight loading until osseous consolidation.

RESULTS: Between January 2009 and November 2011, minimally invasive plate osteosynthesis using the minimally invasive cerclage passer or the collinear reduction clamp was performed in 21 patients with 23 distal femoral fractures. None of the patients suffered from postoperative malalignment or malrotation. Mean time to adequate fracture consolidation was 128 days (range 53-470 days).