Reamed Locked Plating - Metaphyseal Fractures of the Distal Femur and Tibia

Comminuted metaphyseal fractures (OTA classification A2/3 and C2/3) of the distal femur and
distal tibia are difficult to treat and typically have more complications than other
metaphyseal fractures. Delayed union, nonunion and need for secondary bone graft procedures
are frequent outcomes. These A2/3 and C2/3 fractures of the distal femur and distal tibia
treated with locked plates often have a critical sized fracture gap (poorly organized
cortical pieces many of which are stripped of soft tissue). Optimal management strategies
that minimize both fracture healing time and complication rates remain controversial.
Primary bone grafts or early secondary bone grafts have been recommended for these
comminuted open fractures, but have not been studied as the primary end point in a
randomized trial. There is a need to study primary bone grafting during open reduction and
internal fixation (plating) of these difficult fractures, to determine if shorter healing
time, and thus less need for reoperation, can be achieved.

Hypothesis Acute autogenous bone grafting at the time of fixation will hasten clinical and
radiographic union with a lower need for secondary procedures