Utility and outcomes of locking compression plates in distal femoral fractures

Abstract

<p class="abstract"><strong>Background:</strong> Supracondylar and intercondylar fractures of femur present a huge surgical challenge. The purpose of this study was to evaluate the rate of union, functional outcome and complications of these fractures treated with open reduction and internal fixation with a locking compression plate- distal femur (LCP-DF).</p><p class="abstract"><strong>Methods:</strong> A prospective study of 26 fractures in 25 patients was done during a period of June 2012 to July 2014. Based on clinical diagnosis and x rays, the fractures were managed by surgery and had a minimum follow up of one year. The decision to fix with Locking compression plates was taken based on extensive comminution, missing bone, poor quality of bone and a combination of these factors. Primary Bone grafting was done in cases of severe medial comminution.<strong></strong></p><p class="abstract"><strong>Results:</strong> Overall 26 fractures were studied. The mean age was 44 yrs. Out of 25 patients, 16/25(64%) were men and 36% were women. There were 10/26 type A and 16/26 type C fractures. There were 57.6% closed fractures and 42.3 % open fractures. Bone grafting was done for 13 fractures. The average time for union in open fractures was 20.60 weeks and 18.53 weeks for closed fractures. The average range of motion for closed fractures was 10- 100.330 and for open fractures was 50- 84.50The results of entire study group showed 4 excellent, 10 good, 5 fair and 6 poor. We saw that 2 of 10 (20%) open fractures had excellent or good results whereas 12 of 15(80%) closed fractures had excellent or good results (p <0.005). The 8 of 10(80%) type A fractures had excellent or good results whereas 6 of 15(40%) type C fractures had excellent or good results (p<0.058). The closed fractures united early as compared to open fractures (p <0.72). The closed fractures had a mean range of 99 degrees movement against the open fractures which had 79 degrees (p <0.36). the type A fractures had a better range of movement( 106 degrees) as compared to type C fractures(81.67 degrees) (p <0.13).</p><strong>Conclusions:</strong> Locking compression plates had better outcome in closed fractures than open fractures. The extra articular (type A) fractures had better outcome than intra articular (type C) fractures. The closed fractures united earlier as compared to open fractures. There was no significant difference in time of union in fractures where bone graft was used and in those where no bonegraft was used. Knee stiffness is a common complication following these fractures. Therefore the distal femoral LCP provides a stable fixation in comminuted fractures.