• Chun-Liang Hsu, Jui-Jung Yang, Tsu-Te Yeh, Hsain-Chung Shen, Ru-Yu Pan, and Chia-Chun Wu.
• Department of Orthopedic Surgery, Tri-Service General Hospital and National Defense Medical Center, 325, Cheng-Gong Road, Section 2, Taipei, 114, Taiwan, Republic of China. Electronic address: windoverture@gmail.com.
• J Formos Med Assoc. 2021 Jan 1; 120 (1 Pt 2): 395-403.

Background/PurposeOrthopaedic Trauma Association (OTA) C-type distal femoral fractures can be very challenging to treat effectively. While locked plating is widely used in the complex distal femoral fracture, failure of locked plate fixation is not uncommon. First, we tried to determine the risk factor related to early failure of multiplanar OTA C-type fracture in the distal femur after fixation with lateral locked plate. Second, we tried to provide a strategy for surgeons to prevent pitfalls of early failure in the complex distal femoral fractures treated with lateral locked plating.MethodsWe retrospectively reviewed 44 adults with OTA C-type fractures of the distal femur treated with locked plate fixation between 2010 and 2016 at Tri-Service General Hospital. Average length of follow-up was 27.6 months (range, 12-54 months). Univariate and multivariate logistic regression were used to determine the association of variables on early failure of fixation. A p-value < 0.05 in univariate and multivariate analyses were considered significant.ResultsThere were six patients experiencing early failure, and the early failure rate was 13.6%. The risk factors associated with early failure of complex distal femoral fracture identified by univariate analysis included sagittal oblique fracture pattern, longer working length and post-operative sagittal malalignment (odds ratio [OR] and 95% confidence intervals [CI]: 90.00 (6.85-1183.33), 0.55 (0.31-0.98) and 8.63 (1.077-69.075) respectively). The multivariate analysis showed only sagittal oblique fracture pattern was associated with early failure [OR: 52.348 (3.06-895.23)].ConclusionSagittal oblique fracture was more likely to result in early postoperative failure. Early recognition of the fracture pattern should be considered to avoid catastrophic results.Copyright © 2020 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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