Follow up study of surgically treated intra-articular fractures of distal femur

Abstract

Background: Fractures of distal femur have been historically difficult to treat because of their unstable or intra-articular nature and their degree of comminution. The proximity of these fractures to the knee joint makes regaining full knee function and motion relatively more difficult. The incidence of malunion, nonunion and infection is also high in these fractures.This has lead many surgeons to abandon conservative measures in favour of open reduction and internal fixation devices. These devices are useful in achieving restoration of bony continuity, maintenance of good reduction, restoration of articular congruity and restoration of early joint movements.Materials and Methods: Present study consisted of periodic follow up of patient with certain standard questions about the degree of pain on weight bearing, range of motion (ROM) of the treated leg, walking ability and resumption of daily activities using Neer Scoring System. Postoperative radiographs evaluated for axial alignment and osteoarthritis and radiological union. The results of surgically treated intra-articular fractures of distal femur were evaluated according to Neer et al scoring.Results: Out of 25 cases, 15 (60%) showed excellent results. younger the average time of union was 13.36 ± 2.69 weeks. Selection of implants was based on the decision of the surgeon during the surgery depending on fracture configuration. There cannot be a fixed rule laid down on this matter. Maximum stability with minimum implants was our aim in choosing the implants. In all cases of excellent results, postoperative mobilization was started within 10 days of surgery. The mean Neer Score was 85.Conclusion: Earlier the surgery, better the results. Comminution of the fracture adversely affects the results. Intra articular comminution is not a contraindication for internal fixation. Active mobilization is the keystone in determining long-term functional outcome. Undisplaced fractures had good results comparing displaced fractures. Displaced fractures with intra-articular extension had bad prognosis, irrespective of the method of treatment adopted.