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Results of Polyaxial Locked-Plate Fixation of Periarticular Fractures of the Knee

¹ Orthopaedic Trauma Service, Florida Orthopedic Institute, 13020 Telecom Parkway, Temple Terrace, FL 33637. E-mail address: docgjh{at}aol.com
² Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
³ New West Sports Medicine and Orthopaedic Surgery, 3219 Central Avenue, Suite 2, Kearney, NE 68847
⁴ Orthopaedic Center, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108
⁵ Regions Hospital, 640 Jackson Street, St. Paul, MN 55101

Investigation performed at the Orthopedic Trauma Service, Florida Orthopedic Institute, Temple Terrace, Florida; the Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota; New West Sports Medicine and Orthopaedic Surgery, Kearney, Nebraska; Orthopaedic Center, University of Utah, Salt Lake City, Utah; and Regions Hospital, St. Paul, Minnesota

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. One or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy). Also, a commercial entity (DePuy) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Methods: Between 2003 and 2005, fifty-four patients with a total of fifty-six fractures were treated with a polyaxial locked-plate fixation system (DePuy, Warsaw, Indiana). There were twenty male patients and thirty-four female patients with a mean age of fifty-seven years. There were twenty-five distal femoral fractures and thirty-one proximal tibial fractures. Twelve of the fractures were open. Clinical and radiographic data, including changes in alignment, hardware breakage, or other mechanical complications of the device, were retrospectively reviewed. Function was assessed with use of the Knee Society scores. One patient with a bilateral fracture died less than three months postoperatively, and two patients were lost to follow-up prior to union. Fifty-two fractures in fifty-one patients were followed to union or for a minimum of six months; the mean duration of follow-up was nine months (range, six to twenty-five months).

Results: Forty-nine (94%) of the fifty-two fractures united. There were no mechanical complications. Most importantly, there was no evidence of varus collapse as a result of polyaxial screw failure. There were three deep infections and one aseptic nonunion. No plate fractured, and no screw cut out.

Conclusions: The variable-axis locking plates performed well, with a high rate of fracture union and no evidence of varus collapse due to failure of the polyaxial screw fixation, in a series of complex fractures about the knee. Complication rates were similar to those for historical controls treated with fixed-trajectory locking plates. Polyaxial locking plates offer more fixation versatility without an apparent increase in mechanical complications or loss of reduction.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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