A COMPARATIVE STUDY ON FUNCTIONAL OUTCOME OF SUPRACONDYLAR FEMUR FRACTURE MANAGED BY OPEN REDUCTION VS MIPPO.

Abstract

Background: Distal femur fractures are complex injuries producing long term disability and present considerable challenges in management. These fractures poses challenges to the treating surgeon because of thin cortex of the femoral condyles, wide medullary canal, relative osteopenia, short condylar fragment and comminution involving articular surface. Distal femur fracture disrupts normal knee joint functioning, hence needed anatomical reduction and stable internal fixation to prevent crippling disabilities and hardware failure Objectives: This study aimed to Compare Functional outcome of supracondylar fracture femur managed by Open reduction VS MIPPO Material & Methods: In this study 30 patients with fracture of distal femur were studied. The method used for fracture fixation was both closed and open reduction with internal fixation with locking compression plate. Patients were selected based on inclusion and exclusion criteria and were followed up ranged from 3 months to 1 year. The results were analysed with NEER'S score. Results: In our study of 30 lower end of femur fractures, 5 was Muller's Type A1; 5 were of Muller's Type A2.; 4 were of Muller's Type A3;2 were B;3 was of Muller's Type C1 ; 9 were of Muller's Type C2; and remaining 2 were Muller's Type C3. Mean age of the patients was 48.4 years with age ranging from 18-70 years with more than two thirds of them being male. Right sided fractures were predominant. RTA being the cause of injury for most of them but there are also cases of fall in the older age group >50 years. MIPPO surgery was done in less time when compared to open reduction.2/3rd of cases done by MIPPO are done in less than 90 minutes when compared to open reduction where the average duration of times was between 90 to 120 minutes accounting 60% of patients. There is not even a single case done by MIPPO with duration of more than 120 minutes. Early radiological union less than 16-18 weeks was seen in most cases of MIPPO technique when compared to OPEN reduction. Open reduction accounted nearly 20% of cases with infections while MIPPO accounted only 6.67% infections mostly of superficial type. There is single implant failure seen in our study that too with MIPPO technique which underwent revision surgery. Better functional outcome was seen in MIPPO procedure accounted 73.33% when compared to open procedure of 66.67%.Poor functional outcome was seen in 13.3% of patients who underwent open reduction and 6.67% cases who underwent MIPPO procedure. Functional outcome was based on NEER's scoring system. Conclusion: Locking compression plate is an important armamentarium in treatment of fractures around knee especially when fracture is severely communited and in situations of osteoporosis. Overall MIPPO has better functional outcome than OPEN reduction especially in extraarticular fractures with comminution as there will be early radiological union,less soft tissue damage,least infection rate which ultimately helps in early physiotherapy and early weight bearing resulting in best functional outcome.