Objectives: We evaluated the clinical and radiologic results of patients treated by the minimally invasive technique and plate fixation in accordance with biological fixation principles for femoral fractures.
Methods: Biological fixation principles were used in the treatment of 24 patients (18 males, 6 females; mean age 32 years; range 18 to 56 years) with femoral fractures. Fractures were reduced by indirect reduction and the plate was forwarded through distal and proximal incisions over the periosteum without the need for incisions on the fracture line. Fixation of the plates was performed with the use of screws from distal and proximal incisions. The patients were allowed partial and full weight-bearing in a mean of 3.6 and 5 months, respectively. By means of monthly clinical and radiologic examinations, union was assessed by callus formation in the fracture line and painless weight-bearing. In addition, leg length discrepancy, rotation, angulation deformities, and knee and hip range of motions were determined. The mean follow-up was 2 years and 7 months (range 16 months to 4 years and 5 months).
Results: The mean union time was 4.6 months (range 4 to 11 months). Except for one patient (4%) with delayed union, all patients achieved union. No infections occurred related to the fracture site.
Conclusion: Successful clinical and radiologic results can be obtained by biological methods of fixation in diaphyseal femur fractures with multiple fragments, segment formation, in multi-trauma patients with high Injury Severity Score and compromised pulmonary function, and in those having subtrochanteric or supracondylar fractures associated with high complication rates.