Fixation Of Distal Femoral Fractures Research Articles

Distal Femoral Fractures in Post‐poliomyelitis Patients Treated with Locking Compression Plates

Treatment of distal femoral fracture in post-polio patients is difficult because the bone is usually osteopenic, small and deformed. This retrospective study aimed to investigate the outcomes of distal femoral fracture in post-polio patients treated by locking compression plates (LCP). The medical records of 19 post-polio patients (mean age 49 years at time of surgery) were reviewed and intraoperative data retrieved. Fracture union and callus formation were evaluated on radiographs taken at each postoperative visit. Functional outcome assessments included range of motion and Hospital for Special Surgery (HSS) score of the ipsilateral knee joint. Sixteen femoral fractures occurred in the poliomyelitis-affected limbs. The mean duration of operation was 86 min and mean blood loss 120 mL. All fractures healed (mean, four months) but union was delayed in one. At the final follow-up 2 yrs after surgery, the mean range of knee flexion was 105° (range, 90°-130°), and mean HSS score 76 points (range, 60-93). There were no cases of nonunion, implant cutout, or other complications. LCP provides stable fixation of distal femoral fractures in post-polio patients. Bony union and good functional outcomes are achieved, but delayed union and minimal callus may occur.

The fixation of distal femoral fracture with antegrade multi-interlocking femoral intramedullary nail

Objective To evaluate the operation methods and curative effect of fixation of distal femoral fractures with antegrade multi-interlocking femoral intramedullary nail (MIFIN).Methods Data of 43 patients who had undergone reduction and fixation with antegrade MIFIN for femoral condyle and supracondylar fractures from January 2003 to December 2011 were retrospectively analyzed.There were 29 males and 14 females,aged from 21 to 78 years (average,35.5 years).Twenty cases of fracture were on the left,while 23 cases on the right,including 40 cases of fresh fracture and 3 cases of old fracture,as well as 5 cases of opened fracture and 38 cases of closed fracture.According to the AO classification,there were 12 cases of type A1,11 cases of A2,7 cases of A3,6 cases of C1,4 cases of C2 and 3 cases of C3.Thirty three patients underwent opened reduction,while 10 patients underwent closed reduction.Results The medullary cavities of 31 patients were not reamed before inserting intramedullary nail,except 3 cases of old fracture and 9 cases of smaller medullary cavity.All patients began functional exercise of the knee 1 to 4 weeks after operation.All of them were followed up for 19.3 to 57 months (average,33.5 months).All fractures obtained bone union,4.3 to 25 months after operation (average,6.2 months).At final follow-up,according to hospital for special surgery (HSS) knee score,the result was excellent in 26 patients,good in 7 patients,fair in 6 patients and poor in 4 patients,and the overall excellent and good rate was 76.74％(33/43).The knee valgus angle was less than 4° in 8 patients,between 4° and 6° in 30 patients,larger than 6° in 5 patients,according to the anterioposterior X-rays.The lateral X-rays showed the knee could extend to 0° in all patients,and the range of flexion was more than 90° in 38 cases,70° to 90° in 3 cases and 45° to 70° in 2 cases.Conclusion The fixation of distal femoral fracture with antegrade MIFIN is satisfactory,while can avoid twice operative injuries,tissue adhesion,dysfunction and infection probability of the knee. Key words: Femoral fractures; Internal fixators; Fracture fixation, intramedullary

The efficacy of different surgical fixation for distal femoral fractures

Objective To investigate the clinical efficacy of different surgical fixation for distal femoral fractures.Methods 82 patients with distal femoral fracture who had been hospitalized during the period of August 2005 to January 2011 were included in this study.Group A ( 19 patients ) received lag screws and multifunctional external fixation,group B ( 20 patients ) locking plates,group C ( 18 patients ) received retrograde intramedullary nails,and group D ( 25 patients ) received condylar buttress plates.The knee function was assessed in the four groups,and the treatment was observed.Results The knee function restored in patients with type-A fracture in the four groups,with no difference ( P＞ 0.05 ).The knee function restored better in the patients with type-C fractures in group B than in those in group A strong ( P＜ 0.05 ),and it was better in group A than in group C ( P＜ 0.05 ),and was better in group D than in group C ( P＜ 0.05 ).Conclusions Locking plate is the best in the treatment of distal femoral fractures,followed by condyle buttress plate.Primary hospitals can choose locking plates or femoral condyle buttress plates based on the economic situation. Key words: Distal femur; Fractures; Fixation

Outcome of periprosthetic distal femoral fractures following knee arthroplasty

IntroductionThe majority of periprosthetic fractures around the knee occur at the supracondylar region of the distal femur. Fixation of distal femoral fractures in osteoporotic bone with short segment remains a challenge, especially after total knee arthroplasty (TKA). Internal fixation of these fractures using locking plates has become popular. The purpose of this study was to evaluate a consecutive series of periprosthetic supracondylar femoral fractures treated with locked periarticular plate fixation with regard to surgical procedure, complications and clinical outcome. Materials and methodsFrom two academic trauma centres, 55 consecutive periprosthetic distal femoral fractures (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association, AO/OTA 33) were retrospectively identified as having been treated with locked plate fixation. Of these, 36 fractures in 35 patients (86.1% female) met the inclusion criteria. Patients had an average age of 73.2 years (range 54–95 years). Fixation constructs for plate length and working length were delineated. Nonunion, infection and implant failure were used as complication variables. Demographics were assessed. Outcome was addressed radiographically and clinically according to Kristensen et al.1 by range of motion and pain. ResultsTwenty-five of 36 fractures (69.4%) healed after the index procedure. Eight of 36 fractures (22.2%) developed a nonunion with three fractures (8.3%) leading to hardware failure. Nine of the 36 patients (25%) were radiographically diagnosed with notching of the anterior femoral cortex. Regarding technical aspects, distance from the anterior flange of the femoral component to fracture was significantly shorter in patients with compared to without anterior notching (t=3.68, p=0.02). Patients who underwent submuscular plate insertion compared to an extensive lateral approach had a reduced nonunion risk (χ2=0.05). No difference in infection rate was found for submuscular procedures compared with open procedures (χ2=0.85). Range of motion was reduced in most of the patients and 13.5% had a persistent loss of extension of 5°. More than 77% of the patients reported no or only mild pain during the last office visit. Range of motion loss did not influence pain. Successful treatment according to Cain et al.2 was achieved in 83%. Using Kristensen's1 criteria, 56% of the knees had acceptable flexion. ConclusionOperative fixation of periprosthetic distal femoral fractures after TKA continues to be challenging. Notching of the anterior femoral cortex should be avoided. Loss of reduction and high failure rates still occur with locked plating and may be related to underlying factors. Indirect reduction and submuscular plate insertion technique reduce nonunion risk.

Minimally Invasive Plate Osteosynthesis Using a Locking Compression Plate for Distal Femoral Fractures

To evaluate treatment outcomes of minimally invasive plate osteosynthesis (MIPO) for distal femoral fractures in 31 patients. 22 male and 9 female consecutive patients aged 21 to 65 (mean, 42) years underwent minimally invasive plate osteosynthesis using a locking compression plate (LCP) for distal femoral fractures. The causes of injury were vehicular accidents (n=24), falls (n=6), and assault (n=1). According to the AO classification, the fractures were classified as types A1 (n=10), A2 (n=7), and A3 (n=14). Most fractures were closed; 3 were Gustilo type-II fractures. Clinical and functional outcomes were assessed using the Knee Society Scores. The mean operating time was 70 (range, 60-100) minutes. The mean length of hospital stay was 9 (6-14) days. The mean time to union was 3.7 (range, 2.8-4.6) months. The mean follow-up period was 18 (14-26) months. At the one-year follow-up, 29 of the patients had good or excellent outcomes. No patient had angular or rotational deformity of >10º. One osteoporotic woman with a type-A1 fracture had implant failure at 10 weeks and underwent revision surgery. Another patient with a type-A1 fracture had persistent pain on the lateral aspect of the distal thigh and underwent implant removal at 22 months. No patient developed deep infection, malunion or nonunion. MIPO using a LCP achieves favourable biological fixation for distal femoral fractures with few complications. Bone grafting is not needed even in cases of metaphyseal comminution. Proper patient selection and preoperative planning are essential to prevent complications.

Internal Fixation of Type-C Distal Femoral Fractures in Osteoporotic Bone

Fixation of distal femoral fractures remains a challenge, especially in osteoporotic bone. This study was performed to investigate the biomechanical stability of four different fixation devices for the treatment of comminuted distal femoral fractures in osteoporotic bone. Four fixation devices were investigated biomechanically under torsional and axial loading. Three intramedullary nails, differing in the mechanism of distal locking (with two lateral-to-medial screws in one construct, one screw and one spiral blade in another construct, and four screws [two oblique and two lateral-to-medial with medial nuts] in the third), and one angular stable plate were used. All constructs were tested in an osteoporotic synthetic bone model of an AO/ASIF type 33-C2 fracture. Two nail constructs (the one-screw and spiral blade construct and the four-screw construct) were also compared under axial loading in eight pairs of fresh-frozen human cadaveric femora. The angular stable plate constructs had significantly higher torsional stiffness than the other constructs; the intramedullary nail with four-screw distal locking achieved nearly comparable results. Furthermore, the four-screw distal locking construct had the greatest torsional strength. Axial stiffness was also the highest for the four-screw distal locking device; the lowest values were achieved with the angular stable plate. The ranking of the constructs for axial cycles to failure was the four-screw locking construct, with the highest number of cycles, followed by the angular stable plate, the spiral blade construct, and two-screw fixation. The findings in the human cadaveric bone were comparable with those in the synthetic bone model. Failure modes under cyclic axial load were comparable for the synthetic and human bone models. The findings of this study support the concept that, for intramedullary nails, the kind of distal interlocking pattern affects the stabilization of distal femoral fractures. Four-screw distal locking provides the highest axial stability and nearly comparable torsional stability to that of the angular stable plate; the four-screw distal interlocking construct was found to have the best combined (torsional and axial) biomechanical stability.

Internal Fixation of Type-C Distal Femoral Fractures in Osteoporotic Bone

Fixation of distal femoral fractures remains a challenge, especially in osteoporotic bone. This study was performed to investigate the biomechanical stability of four different fixation devices for the treatment of comminuted distal femoral fractures in osteoporotic bone. Four fixation devices were investigated biomechanically under torsional and axial loading. Three intramedullary nails, differing in the mechanism of distal locking (with two lateral-to-medial screws in one construct, one screw and one spiral blade in another construct, and four screws [two oblique and two lateral-to-medial with medial nuts] in the third), and one angular stable plate were used. All constructs were tested in an osteoporotic synthetic bone model of an AO/ASIF type 33-C2 fracture. Two nail constructs (the one-screw and spiral blade construct and the four-screw construct) were also compared under axial loading in eight pairs of fresh-frozen human cadaveric femora. The angular stable plate constructs had significantly higher torsional stiffness than the other constructs; the intramedullary nail with four-screw distal locking achieved nearly comparable results. Furthermore, the four-screw distal locking construct had the greatest torsional strength. Axial stiffness was also the highest for the four-screw distal locking device; the lowest values were achieved with the angular stable plate. The ranking of the constructs for axial cycles to failure was the four-screw locking construct, with the highest number of cycles, followed by the angular stable plate, the spiral blade construct, and two-screw fixation. The findings in the human cadaveric bone were comparable with those in the synthetic bone model. Failure modes under cyclic axial load were comparable for the synthetic and human bone models. The findings of this study support the concept that, for intramedullary nails, the kind of distal interlocking pattern affects the stabilization of distal femoral fractures. Four-screw distal locking provides the highest axial stability and nearly comparable torsional stability to that of the angular stable plate; the four-screw distal interlocking construct was found to have the best combined (torsional and axial) biomechanical stability.

Condylar Buttress Plate versus Fixed Angle Condylar Blade Plate versus Dynamic Condylar Screw for Supracondylar Intra-Articular Distal Femoral Fractures

To compare outcomes of 3 fixation techniques for intra-articular distal femoral fractures. Records of 59 men and 49 women aged 16 to 80 (mean, 47) years who underwent internal fixation for 116 type-C (complete intra-articular) distal femoral fractures were retrospectively reviewed. According to the AO classification, 25 fractures were type C1 (23 closed and 2 open), 71 type C2 (69 closed and 2 open), and 20 type C3 (16 closed and 4 open). Based on implant availability at the time, all surgeries were performed by a single surgeon using a condylar buttress plate (n=38), a fixed angle (95 degrees) condylar blade plate (n=24), or a dynamic condylar screw (n=54). The mean follow-up period was 11 (range, 4-19) years. At the latest follow-up, functional outcome was classified according to Schatzker and Lambert criteria. Functional outcomes were excellent in 64 (55%) of the fractures, good in 37 (32%), moderate in 9 (8%), and poor in 6 (5%). Outcomes in patients treated by the dynamic condylar screw were significantly superior to those treated by the condylar buttress plate (p=0.016) or condylar blade plate (p=0.001). Good-to-excellent results were achieved in 96% vs 84% vs 71% of these patients, respectively. Complication rates were lower in the dynamic condylar screw group than the other 2 groups (pseudarthrosis, 5% vs 11% vs 25%; varus deformity, 4% vs 26% vs 25%; knee stiffness, 0% vs 5% vs 8%, respectively). No implant failure was encountered. Dynamic condylar screw fixation for distal femoral fractures achieves better functional outcomes and lower complication rates.

Clinical analysis of three internal fixators for femoral fractures

Objective To evaluate clinical effects of 95°angled blade plate(ABP),dynamic condylar screw(DCS)and retrograde intramedullary nail(RIN)used in intemal fixation for distal femoral fractures. Methods Ninety-two cases of distal femoral fractures were included in this study.Their age ranged from 31 to 68 years,with an average of 53.6 years.Of them,22 were treated with 95°ABP,29 with DCS and 41 with RIN.Their functional and radiographic outcomes were collected to compare the differences in bone union time,operation time,intra-operative blood loss,and functional scores according to Kolment rating system. Results They were followed up for 12 to 36 (average,18)months.There was no significant difference in bone union time among the 3 groups(P>0.05),but a significant difference in operation time,intra-operative blood loss and functional scores in favor of RIN(P<0.05).X-ray films showed all fractures got united within 4 months except one case that had used bone cement at fracture site.Refracture occurred 6months postoperatively in ODe patient treated with RIN. Conclusion RIN is superior to the other two fixatom for distal femoral fractures because of advantages of short operative time,less iatrogenic trauma,convenient reduction and rigid fixation. Key words: Femoral fraetures; Fracture fixation; internal; Follow-up studies

The clinical and radiological outcomes of the LISS plate for distal femoral fractures: A systematic review

Purpose The purpose of this systematic review was to assess the literature evaluating the clinical and radiological outcomes following less invasive surgical stabilisation system (LISS) fixation of distal femoral fractures (AO 32/33). Methods A review of EMBASE, Medline, CINAHL and AMED from their inception to November 2008, sources of grey literature and a pertinent hand search of specialist orthopaedic journals was undertaken. Results Twenty-one studies assessing 663 patients with 694 fractures were reviewed. The findings suggest that the LISS system may be an appropriate fixation method for the management of distal femoral fractures. However, there remains a high incidence of loss of reduction ( n = 134; 19%), delayed or non-union ( n = 40; 6%) and implant failure ( n = 38; 5%). On analysis, such complications were largely confined to articles published before 2005, therefore during the infancy of the widespread clinical application of this trauma system. On critical appraisal, the evidence-base remains limited by recruiting small, under-powered sample sizes and poorly accounting for confounding variables such as osteoporosis, diabetes, multi-trauma and fracture classification. Conclusion Further study is required to assess the outcomes of LISS fixation in specific patient populations, and to compare the outcome of this fixation method to condylar plates and intrameduallary devices, to determine the optimal management strategy for this complex patient group.

Mega Prosthetic Knee Replacement For Treatment of Resistant Distal Femoral Non Union

The incidence of non-union in distal femoral fractures has been reported from 0 to 13%. Treatment of these fractures has always been challenging and there is still no established consensus on ideal treatment of nonunion of such fractures. Preservation of knee function and early weight bearing should be the objectives of management to have best clinical outcome. We report treatment of three cases of distal femoral fractures which had failed to unite despite prior internal fixation with a distal femoral tumor endoprosthesis (megaprosthesis) originally developed for use in musculoskeletal tumor surgery as a treatment option as an alternative to internal fixation. The Knee Society Score increased form 35 to 78 & Knee Society Function Score increased form 5 to 80 in these patients. Our patients had good range of motion (70-90 degree flexion) at 8 months of follow up and were walking pain free without the need of any ambulatory support. We thus conclude that cemented Megaprosthesis appears to be a viable one time treatment solution for failed internal fixation of distal femoral fractures, associated with distal femoral bone loss and secondary knee arthritis with or without ligamentous instability in elderly patients.

Fixation of Distal Femoral Fractures With the Less Invasive Stabilization System: A Minimally Invasive Treatment With Locked Fixed-Angle Screws

The Less Invasive Stabilization System (LISS) is an internal fixator, which combines closed reduction of the diaphysis or metaphysis of distal femur fractures with locked unicortical screw fixation. In a retrospective consecutive study, 50 patients with Association for the Study of the Problems of Internal Fixation/Orthopaedic Trauma Association (AO/OTA) type 33-A1 to 33-C3 fractures were treated with the LISS between January 1999 and December 2003. Final results were assessed using the functional score of Neer after a median follow-up of 29 months (15-48 months). Fifteen male and 16 female patients were followed up. The mean age was 49 years (17-90 years). Deep wound infection was seen in one patient (3%) and malpositioning with cutting-out of the proximal screws was in two patients (6%). All other fractures healed uneventfully without bone graft requirements after a mean of 12 weeks (7-20 weeks). A revised osteosynthesis was performed for correction of a valgus deformity of 20 degrees after 4 months. There was no difference in leg length exceeding 2 cm. One patient had a valgus deformity of 10 degrees combined with a rotational deformity of 10 degrees. Range of motion of the knee joint was >120 degrees in 15 patients (48%); 12 (39%) had a range of motion between 90 degrees and 120 degrees and 4 (13%) between 70 degrees and 90 degrees. The function according to the Neer score was excellent in 15 (48%), good in 10 patients (32%), and fair in 6 patients (20%). The mean Neer score was 80 (60-100). The LISS promotes early mobilization and rapid rates of bony and clinical healing without bone grafting with low rates of infection.

The Effect of Plate Rotation on the Stiffness of Femoral LISS: A Mechanical Study

Malposition of the femoral Less Invasive Stabilization System (LISS) plate may alter its biomechanical behavior. This study compares the mechanical stability of "correctly" affixed LISS plates matching the slope of the lateral femoral condyle to "incorrectly" placed LISS plates fixed in external rotation relative to the distal femur. A fracture gap model was created to simulate a comminuted supracondylar femur fracture (AO/OTA33-A3). Fixation was achieved using two different plate positions: the LISS plate was either placed "correctly" by internally rotating the plate to match the slope of the lateral femoral condyle, or "incorrectly" by externally rotating the plate relative to the distal femur. Following fixation, the constructs were loaded in axial, torsional, and cyclical axial modes in a material testing machine. Stiffness in axial and torsional loading; total deformation and irreversible (plastic) deformation in cyclical axial loading. The mean axial stiffness for the correctly placed LISS constructs was 21.5% greater than the externally rotated LISS constructs (62.7 N/mm vs. 49.3 N/mm; P = 0.0007). No significant difference was found in torsional stiffness between the two groups. Cyclical axial loading caused significantly less (P < 0.0001) plastic deformation in the correct group (0.6 mm) compared with externally rotated group (1.3 mm). All the constructs in the incorrect group failed, where failure was defined as a complete closure of the medial fracture gap, prior to completion of the test cycles. Correct positioning of the LISS plate for fixation of distal femur fractures results in improved mechanical stability as reflected by an increased stiffness in axial loading and decreased plastic deformation at the bone-screw interface.

Assessment of Fragment Micromotion in Distal Femur Fracture Fixation with RSA

To assess fragment micromotion in three fracture fixation constructs 18 composite femur models were sectioned to create AO-C3 fractures and fixed using the Less Invasive Stabilization System (LISS), Dynamic Condylar Screw (DCS), or the Condylar Buttress Plate (CBP). Tantalum beads were attached to each fracture fragment. The constructs were tested for permanent deformation after cyclical loading (amplitude = 242.2N) and elastic deformation during static loading with 490.5N. Radiographs were taken before loading and then after unloading to determine permanent deformation or during loading to determine elastic deformation. We used RSA to quantify the six degrees of freedom interfragmentary maximum total motion, strain, and stress. For maximum total motion the CBP had more permanent deformation and two failures, whereas the LISS underwent the greatest elastic deformation. LISS and CBP had the highest strain conditions in the fracture gap and LISS had the greatest stress movements between fragments, all of which exceeded the upper limits for bone healing. LISS and CBP may not be indicated for comminuted fractures due to the high degree of flexibility of the LISS, resulting in high stress and strain conditions and susceptibility to catastrophic failure and high strain conditions with the CBP.

Biomechanical Evaluation of the Less Invasive Stabilization System and the 95-degree Angled Blade Plate for the Internal Fixation of Distal Femur Fractures in Human Cadaveric Bones with High Bone Mineral Density

The less invasive stabilization system (LISS) is an internal fixator that utilizes unicortical locked screws for fixation of distal femur fractures. A question is whether locked unicortical screw fixation is sufficient, when compared with a standard implant such as a blade plate. Eight matched pairs of fresh-frozen cadaveric femora were instrumented with either the LISS or a 95-degree blade plate. A 4-cm supracondylar gap fracture model was created and all bone-implant constructs were tested to failure in axial loading. All constructs failed by plastic deformation of the implant. There was no significant difference between the LISS and the blade plate constructs with respect to load to failure. Despite unicortical fixation axial loading to failure of the LISS did not result in implant/screw pull-out neither proximally nor distally. However, there does not appear to be a biomechanical advantage of using the LISS as opposed to a blade plate in bones with high bone mineral density.

A New Guide for Condylar Blade-Plate on Distal Femoral Fractures

This article presents a new guide used to reduce the risk of malalignment following distal femoral fracture fixation with a 95 degrees angled blade plate.

Effect of Alternative Splinting at Extension and 90degrees Flexion on Range of Motion after Open Reduction and Internal Fixation of Distal Femur Fracture

Effect of Alternative Splinting at Extension and 90degrees Flexion on Range of Motion after Open Reduction and Internal Fixation of Distal Femur Fracture

Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures.

To summarize the complications and early clinical results of 123 distal femur fractures treated with the Less Invasive Stabilization System (LISS; Synthes, Paoli, PA). Retrospective analysis of prospectively enrolled patients. Two academic level I trauma centers. One hundred nineteen consecutive patients with 123 distal femur fractures (OTA type 33 and distal type 32 fractures) treated by 3 surgeons. One hundred three fractures (68 closed fractures and 35 open fractures) in 99 patients were followed up at least until union (mean follow-up = 14 months, range: 3-50 months). Surgical reduction and fixation of distal femur fractures. Perioperative complications, radiographic union, infection rate, loss of fixation, alignment, and range of motion. Ninety-six (93%) of 103 fractures healed without bone grafting. All fractures eventually healed with secondary procedures, including bone grafting (1 of 68 closed fractures and 6 of 35 open fractures). There were 5 losses of proximal fixation, 2 nonunions, and 3 acute infections. No cases of varus collapse or screw loosening in the distal femoral fragment were observed. Malreductions of the femoral fracture were seen in 6 fractures (6%). The mean range of knee motion was 1 degrees to 109 degrees . Treatment of distal femur fractures with the LISS is associated with high union rates without autogenous bone grafting (93%), a low incidence of infection (3%), and maintenance of distal femoral fixation (100%). No loss of fixation in the distal femoral condyles was observed despite the treatment of 30 patients older than 65 years. The LISS is an acceptable surgical option for treatment of distal femoral fractures.

Protein C, protein S, antithrombin III, and hyperfibrinogenemia in deep vein thrombosis (DVT) among patients who underwent high risk orthopaedic surgery

Post operative DVTÂ&nbsp; is believed to be rare in Indonesia, and so is trombophilia. It is necessary to know&nbsp; the incidence of postoperative DVT in Indonesia and thrombophlia profile (protein C, S, AT III deficiency and hyperfibrinogenemia) in DVT and non DVT patient who underwent orthopedic surgery involving the hip and knee (high risk surgery). A cross sectional study was conducted in 20 patients who underwent surgery&nbsp; involving the hip (total hip replacementÂ&nbsp; and fixation of proximal femoral fracture) and knee (total knee replacement and fixation of&nbsp; distal femoral fracture). Protein C, protein S, antithrombin III, and fibrinogen were examined in day 5 post operative, as well as with compression/Doppler USG between day 10 to 21 post operative, and confirmed by venography&nbsp; if USG findings was positive. Post operative DVT were found in 5 of&nbsp; 20&nbsp; patients (25%). Deficiency of protein C (P= 0.46) protein S (P= 0.81), antithrombin III (P= 0.46), and hyperfibrinogenemia (P= 0.0547) did not correlate to post operative DVT. However, hyperfibrinogenemia was found to be a risk factor to post operative DVT (attributable risk= 1). Other confounding factor such as diabetes mellitus (P= 1.0), obesity (P= 0.28), hypertention (P= 1.0), hypertrigliseridemia, and hypercholesterolemia did not correlate to post operative DVT. The study suggested&nbsp; the existence of postoperative DVT cases&nbsp; in Indonesia. Hyperfibrinogenemia is a risk factor to promote post operative DVT. Deep vein thrombosis&nbsp; did not correlate to protein S, protein C, and antithrombin III deficiency. (Med J Indones 2004; 13: 24-30) Keywords: Thrombophilia, hip, knee, venography

Evolution of Minimally Invasive Plate Osteosynthesis (MIPO) in the femur

Problems with conventional open reduction and internal plate fixation of distal femoral fractures are well established. These problems have been associated with extensile exposures of the fracture site. “Biological plating”, like intramedullary nail fixation, of distal femoral fractures preserves the soft tissues about the fracture, and is associated with early fracture consolidation and low rates of infection. Anatomical restoration of the articular surface continues to be the main goal in the treatment of these fractures regardless of the stabilization technique. Submuscular plating techniques, which provide for closed reduction of the diaphyseal/metaphyseal component of the fracture, have improved significantly.