A Unique Modality for treating Open Supracondylar fracture Femur with Bone Loss. (Gustillo Anderson – 3B)

Abstract

Background: Various treatment modalities are used for the treatment of GA-3B injury, yet determining the choice of treatment is difficult. We report fifteen such cases, of which twelve were treated with DCS and 950 plate and three with LCP because of minimal bone stock at the distal end (condyles) along with non- vascularised dual ipsilateral fibular strut graft and cancellous bone grafts from iliac crest. Materials and Methods: We performed this study from 2000 – 2014. We studied Total 1176 cases of supracondylar fracture femur of which 15 were of type GA-3B. The study consisted of eight males and seven females, eleven were right sided and four left sided. Fifteen patients underwent surgery (twelve were treated with DCS and 950 plate, three with LCP plate) with dual ipsilateral fibular strut graft and cancellous bone graft from iliac crest. Thirteen had functional range of movement (avg 0-1170), one had range of movement 0-70o and one had range of movement 0-15o at knee joint. Fractures united in all fifteen patients with average period of union twelve weeks and all returned to previous work. Immediate treatment consisted of debridement, primary closure, proximal tibial skeletal traction and broad spectrum i/v antibiotics. Once the wound was healed, surgery (open reduction internal fixation (ORIF) with plating with ipsilateral dual fibular strut grafts and cancellous graft) was performed. Result and Conclusion: We performed two-stage surgery in all the cases. First in the form of debridement and skeletal traction and secondly, definitive fixation was carried out. The current study demonstrated that ORIF with (DCS and 950 / LCP) plate with dual ipsilateral non-vascularised fibular strut graft and cancellous bone grafts from iliac crest is a good modality for open supracondylar fracture femur with bone loss with good results and functional range of movement. This is a small study with favorable results. However, it requires large study group to prove this technique beneficial for treating such fractures. Keywords: GA-3B, bone loss, fibular strut graft, iliac graft, 95 DCS, LCP.