Ninety-five degree angled blade plate fixation of high-energy unstable proximal femur fractures results in high rates of union and minimal complications

Objectives:To describe the surgical technique and clinical outcomes of high-energy proximal femur fractures treated with a 95-degree angled blade plate.Design:Retrospective case series.Setting:Single academic Level I trauma center.Patient/Participants:Forty-five consecutive patients from March 2012 to April 2017 who sustained a high-energy, unstable proximal femur fracture including (OTA/AO 31-A1, 31-A2, 31-A3, 31-B3, 32-A1a, and 32-C3i).Intervention:Open reduction internal fixation with a 95-degree angled blade plate used in conjunction with an articulated tensioning device.Main Outcome Measurements:Nonunion, malunion, secondary operations, and postoperative infection.Results:Twenty six patients were available for follow-up. The mean age was 43.8 (range 22-86) years, and 81% (21/26) were men. The most common fracture pattern was OTA/AO 31-A3.3. Two fractures were open. The articulated tensioner was used in 100% of cases. Average clinical follow-up was 19.2 (range 7-40) months. Twenty-four of 26 patients (92%) achieved osseous union after the index procedure. One patient underwent nonunion repair, and 2 patients had the blade plate removed as it was symptomatic laterally. No other secondary procedures were performed, and no instances of implant failure were seen. No patients had evidence of a superficial or deep infection.Conclusions:We found that high-energy proximal femur fractures treated with a 95-degree condylar blade plate and articulated tensioning device had a high rate of union with minimal postoperative complications. Although intramedullary nailing of these fractures remains a preferred treatment modality, the angled blade plate with articulated tensioning device is an excellent option to restore anatomical alignment and obtain bony union in certain highly comminuted fracture patterns.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.