Plate on Plate Osteosynthesis : A Novel Method For Periplate Fracture Fixation

Periplate fractures may occur after plate fixation, especially in osteoporotic and non-united bones. We present a case of locking plate fixation over an existing plate for such fractures. CASE PRESENTATION: 58 years old man slipped and fell in sitting position 8 months post left distal femur LCP. He sustained pain and swelling of the left hip. The left thigh was externally rotated and shorter than the normal side. X-rays revealed a periplate fracture extending to the subtrochanteric region. A reverse right distal femur LCP was planned. A minimally invasive approach was used. Proximal screws were removed from the original plate and new screws were inserted through both plates which were of similar material, Titanium. DISCUSSION: Elderly population makes a large subgroup of the cases due to osteoporosis and rigidity of the LCP construct2. This fixation provides a simple method to reduce surgical time, bleeding, and preserving more blood supply to enhance fracture healing, as opposed to using nails supplemented with cerclage/cable wires. Care should be taken to use the pre-existing screw holes in the overlapping segment of the two plates, as well as similar plate materials to avoid stress risers and reduce corrosion(1). CONCLUSION: Plate on plate osteosynthesis is a novel method that may prove valuable due to the increasing population age and unique types of fractures. Further research is needed to determine any complications related to this type of fixation. REFERENCES: 1. Georgios Arealis et. al Plate On Plate Osteosynthesis For The Treatment Of Non Healed Periplate Fractures, Hindawi Publishing Corporation, Volume 2014, Article 367490. 2. S. Ruchholtz, et al., “Less invasive polyaxial locking plate fixation in periprosthetic and peri-implant fractures of the femur—a prospective study of 41 patients,” Injury, vol. 44, no. 2, pp. 239–248, 2013;