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1Principles

Final osteosynthesis

General considerations

The Condylar LCP is a modification of the former condylar buttress plate, which was used over the last three decades for treatment of multifragmentary articular fractures. The major problem with use of the condylar buttress plate was varus collapse and loss of fixation of the distal femoral articular block, especially with a short distal segment and/or osteoporosis. The major improvement in the Condylar LCP, as compared to the condylar buttress plate, has been the addition of locking-head screws in the plate, producing angular stability.

The locking head screws distally have prevented varus collapse, even in cases of osteoporosis. Locking-head screws both proximally and distally have made loss of fixation rare.

The Condylar LCP can be used in either an open, or a minimally invasive manner. When inserted in an open manner, a lateral approach is used. This is most common in extraarticular and complete articular fractures with a simple articular component. As with a 95° blade plate, if the plate is positioned on the distal femoral block in the appropriate position, the correct axial alignment (varus/valgus) of the distal femur fracture is ensured. A careful preoperative plan will allow the surgeon to know where the central 7.3 mm screw should be positioned in the distal femoral articular block. This requires preoperative templating of the uninvolved contralateral limb. Thereby, the implant, when placed in the appropriate position distally, helps the surgeon to reduce the fracture.

Alternatively, the implant can also be used in a minimally invasive manner. As with LISS fixation, the reduction of the metaphyseal / diaphyseal component of the fracture should be secured before fixation. Reduction aids are similar to those for the LISS fixation: anesthetic muscle relaxation, supracondylar bolster, manual traction, Schanz pins and external fixation. The advantage of closed reduction / internal fixation is a greater preservation of the fracture biology in the metaphyseal / diaphyseal area. This leads to higher union rates, less infection and fewer wound complications. Closed reduction techniques are generally employed when the surgeon is faced with a complex comminuted metaphyseal fracture. Fractures with a simple, one-plane fracture pattern are generally approached in an open manner, with direct clamp application.

In extra-articular wedge and multifragmentary fractures, the Condylar LCP functions as a bridging device, by passing the comminuted metaphyseal zone.