Management Of Distal Femoral Fractures Research Articles

The use of knee mega-prosthesis for the management of distal femoral fractures: A systematic review

IntroductionDistal femur fractures (DFFs) are unusual and difficult to deal, especially in elderly patients. A consensus about a gold-standard treatment has not been reached yet. Available options include both conservative and surgical management. In elderly patients a prosthetic replacement could be a valid treatment option. Literature is lacking about the use of mega-prosthesis in this type of fractures. The purpose of the present systematic review is to examine which fracture, both acute and chronic, involving distal femur should be treated by using a mega-prosthesis. Materials and MethodsStudies were identified by searching electronic databases. All studies that enrolled people of any age affected by a DFFs treated by using a megaprosthesis were included. Primary outcomes of the present reviews were: ROM, functional assessment and complications. Two review authors independently selected eligible trials. Disagreements at any stage were resolved by consensus or a third party adjudication. Descriptive statics was used to summarize the data. ResultsThirteen article were finally included in the review. One hundred-four patients were treated with knee megaprosthesis. Three categories of patients were identified: 29 patients were affected by supracondylar femur fracture; 51 patients occurred with a periprosthetic fracture; 24 patients suffered a non-union of a previous supracondylar fracture. The follow-up varied between 6 months to 58 months. All studies showed good results in terms of improving quality of life, resuming activities of daily living (ADLs), early mobilization, ROM, shorter hospital stay. Although not frequent, the only reported complications were infection and aseptic loosening. DiscussionThe present review showed that the use of knee megaprosthetic implants could represent a valid treatment option aiming to reduce patients’ immobilitazion and hospital stay. Good clinical outcomes with low rate of complications were reported by all included studies. Literature is lacking about long-term outcomes and complications. Moreover studies comparing knee prostheses and other types of surgical treatment (intramedullary nails, plate fixation system) are needed. ConclusionsMegaprosthesis represent a viable treatment option in patients affected by DFFs (either acute, periprostethic or non-union) because they allow immediate weight-bearing, shorter hospital stay, a fast recovery of knee function and ADLs.

A PROSPECTIVE STUDY OF FUNCTIONAL OUT COME OF DISTAL FEMUR FRACTURE WITH INTRA ARTICULAR EXTENSION USING NEWER RAINA`S APPROACH WITH BICOLUMN PLATING

Management of distal femur fractures has evolved from conservative treatment resulted in mal alignment & immobilizations and associated complications, the surgical methods promoted AO internal fixation to regain the full functional range of movements , the conventional approach for distal femur fractures with intra articular extension is through the lateral approach the exposure of intra articular fracture fragments is difficult, other surgical approaches have been reported for distal femur fractures with intra articular extensions but all of them have own limitations. In Olerud using extensible midline Y incisions with elevation of tibial tubercles, the exposure to the intra articular fragments is adequate but chances of tibial tuberosity nonunion and skin necrosis is high, swashbuckler approach is an antero- lateral approach provides inadequate approach to medial condyles. In our study we would like to assess the functional outcome of Raina’s approach for reconstruction of distal femur fractures Keywords: Distal Femur Fracture, Raina Approach

Management of distal femoral fractures treated with locking compression plate: a prospective study

<p class="abstract"><strong>Background:</strong> Distal femoral fractures are extremely common and represent 6-8% of all the femoral fractures treated by orthopaedic surgeons. Near anatomical reduction is most important in these fractures to obtain near good functional results. A variety of treatment options are proposed for distal femoral fractures of the treatment with distal femoral LCP has yielded good results. In this study we did a prospective study of 30 patients treated with locking compression plates.</p><p class="abstract"><strong>Methods:</strong> There were 30 patients both male and female of different age groups treated by plate. All the patients were followed up in orthopaedic department prospectively for 12 months between November 2017 to November 2018. The functional and radiological outcomes were assessed.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study included 30 patients both male and female in age group between 20 and above 60. Average follow up was 12 months using Neer’s scoring system we had excellent 60%, good 26.6%, fair 6.7%, poor 6.7%.</p><p class="abstract"><strong>Conclusions:</strong> The locking compression plate along with active physiotherapy proved to be better for distal femoral fractures.</p>

Management of distal femur fractures with locking compression plate: A prospective study

Management of distal femur fractures with locking compression plate: A prospective study

Management of distal femur fractures with bicolumnar fixation with condylar buttress plate and TENS nail

Introduction: The fracture of distal femur are often unstable and comminuted and as difficult to treat. The incidence of complications in these fracture are relatively high. We have treated the fracture of distal femur with comminuted medial wall with condylar buttress plate and support of medial wall with TENS nail.Material and Methods: Fifty three patients with intercondylar fracture of distal femur were selected. There were thirty three males and twenty females. The average age of the patients was 36.2 years. All the patients were operated between 3 to 7 days. The final outcome was assessed according to schatzker and Lambert scoring system. The complications were also noted.Results: The result was excellent in fifteen, good in twenty three, fair in eleven and poor in four patients according to schatzker and Lambert scoring system. The average time to Union was 14.2 weeks. Complications include superficial wound infection in five patient, knee stiffness, and varus angulation less than 5 degree in eight and five patients respectively.Conclusion: The use of TENS nail for medial femoral defect along with condylar buttress plate may eliminate the need of plate on medial side. The varus angulation that occurs with defect is decreased and additional long incision and operative time is avoided.

Analysis of functional outcome of IMSC (Intra medullary supracondylar) nail for distal femoral fractures

The distal femur is an area that is particularly vulnerable to the dangers of our modern life styles and high velocity methods of transportation. Among young patients, fractures of the distal femur usually are a component of multiple traumas sustained through high – velocity, high-impact injuries such as motor vehicle accidents or fall from a height.Objectives: To analyze the functional outcome of distal femoral fractures treated by retrograde intramedullary nailing.Materials and Methods: Between January 2016 and June 2018, 11 distal femoral fractures in 10 patients were operated using retrograde intramedullary nail at tertiary care hospital Surat. There were 7 (70%) males, & 3 (30%) were females; Age was ranging 18-74 years, with an average of 43.4 years. 7 patients were due to polytrauma.Fractures were classified according to Muller’s classification, 4.76% were Type A1, 14.8% were Type A2, 42.8% were Type A3, 9.52% were Type C1, 14,28% were Type C2 and 14.28% were Type C3. All the cases were operated with retrograde intramedullary nailing using patellar splitting approach.Observations: The mean operative time was 19 minutes (16 to 240 minutes). Primary bone grafting was done in 2 cases (19%), Open reduction was done in 2 cases. Post operatively knee mobilization was done using CPM. The average follow up interval was 13 months (3 to 36) months.Results: All fractures healed by 4 months range 3 to 3.5 months. The mean knee range of movements was 980 (800 to 1400). There was deep infection in one case, shortening more than 2 cm in one case, 80 valgus angulation in one case, anterior knee pain in 1 case and implant protruding to knee joint in 1 case. There were no late mechanical failures of the implant.Neer’s knee rating system was used to evaluate the function, there were 3 (30%) excellent, 5 (50%) satisfactory results, 1 (5%) was unsatisfactory results and 1(5%) of the case failed. The results correlated with age of the patient and the presence of an intra- articular fracture.Conclusion: This study shows distal femoral fractures were common in males due to high velocity injuries. Retrograde intramedullary nailing is an excellent technique for management of distal femoral fractures since there is less soft tissue dissection. The preferred portal of entry can be reached quickly & effectively, shortens the duration of surgery, decreases the need for bone grafting, high union rate and good knee range of movements. Complications were few, which includes infection, shortening, angulation and anterior knee pain.

Extra Articular Distal Femoral Fractures in the Elderly Treated with Retrograde Nailing Using a Spiral-Locking Blade System.

Background:The number of elderly patients sustaining long bone fractures is increasing with the rise of elderly population in the western world. Management of distal femur fractures is particularly difficult due to osteoporosis and other associated comorbidities. The key to management would be by surgical stabilization, which allows early mobilization. This study was devised to look into the radiological outcome and complication rate in a series of elderly patients who were treated with retrograde nail using spiral locking blade system for extra articular distal femur fractures.Materials and Methods:This is a retrospective study of patients who have undergone retrograde nailing with spiral-locking blade for distal femoral fractures (extra articular) above the age of 70 years in a major trauma center from 2001 to 2015. Notes were assessed for postoperative complications; time to union and final postoperative followup radiographs were assessed for alignment using a scoring system.Results:Forty one patients with an average age of 80 years and an average followup period of 9 months were included. The mean radiological score at final followup was 10.34 (range 8–12), with no significant shortening in any of the patients. Thirty patients had excellent radiological score (>10) and 11 patients scored good (8–9). The difference in time to union between Group 1 – simple fracture pattern (3.42 months) and Group 2 – complex comminuted fracture pattern (4.74 months) was not statistically significant (P = 0.072). There were five delayed unions but no cutout or metal work failure.Conclusion:The retrograde femoral nail with distal spiral-locking blade system can be a good surgical option for the treatment of extra articular distal femoral fractures in the elderly with the possibility of early weightbearing.

Indications for Distal Femoral Replacement Arthroplasty in Acute Geriatric Distal Femoral Fractures

Distal intraarticular femoral fractures in the elderly are associated with significant morbidity and mortality and represent a difficult clinical situation for the treating orthopaedic surgeon. Challenges are due to high levels of comminution secondary to osteoporotic bone which limits traditional fixation techniques. Furthermore, these injuries occur in the setting of patients with complex medical co-morbidities which benefit from rapid mobilization. Primary distal femoral replacement arthroplasty has emerged as a viable option for the management of distal femoral fractures in the native knee in the elderly population. In the appropriate patient population, surgeons should consider this technique in the acute setting.

Prospective study of 30-cases of fracture distal third femur managed by retrograde distal femoral intramedullary nail

Background and objectives: Fracture of distal third of femur is encountered because these fractures most often result from high velocity injuries as femur is the largest bone of the body. It is one of the principal load bearing bones in the lower extremity [1]. One must have a high index of suspicion for complications or other injuries as it can cause prolonged morbidity and extensive disability like joint stiffness due to post traumatic arthritis unless treatment is appropriate. Distal femur fractures make up to 6% of all femoral fractures. Most high energy distal femoral fractures occur in males 15-50 years and low energy fractures occur in osteoporotic women more than 50. Most commonly RTA 53% and fall at home 33% [7]. In rural India, workplace injury such as fall from height is also common. Currently surgery is indicated for femur fractures because of high rate of union, low rate of complication and advantage of early stabilization which decreases morbidity and mortality in patients. Regardless of the method of treatment, the following principles are agreed upon i.e. restoration of alignment, rotation and length, preservation of blood supply to aid union, prevent infection, rehabilitation of the extremity and there by the patient [4]. A method closely approaching this perfection is retrograde intramedullary interlocking nailing which improves the torsional and axial stability and offers a more biological method of fixation with less devitalisation of soft tissues [4, 8]. It has improved post-operative knee function with decreased operative time, blood loss, bone grafting, and non-union rates [8]. Result is early recovery, lesser hospital stay, early rehabilitation with good results and is economical [6]. Surgical stabilization of osteoporotic bones and pathological fractures has increased due to retrograde nails [6].The present study is to understand the functional outcome and to minimize operative mistakes and complications of surgical management of distal femur fractures with retrograde nailing.Methods: 30 patients with supracondylar femur fracture were studied, in Anil Neerkonda Hospital, NRI institute of Medical Sciences. Visakhapatnam in between June 2016 to May 2018. RIS nail was inserted through intercondylar notch. These nails have advantage of being load shearing devices, requiring little soft tissue dissection, infrequently needing bone grafting and technically easier. Preserving fracture hematoma, decreased blood loss, less operative time and decreased infection.Results: In 30 patients, male predominate (93.3%) in this study. RTA was the chief cause of fracture. Surgery was performed within 1.9 days average, there were 5 open type and 25 closed type of fracture. radiological union was seen in 16-24 weeks. Average patient was followed up for 6 months. Average knee flexion was 115°. 1 died, 1 screw breakage and 2 had pulmonary embolism. 3 shortening of limb, 3 stiffness and 7 delayed union. 15(51.7%) excellent results, 6(20.6%) good results, 7(24. %) fair results and 1(3.4%) poor result.Interpretation and Conclusion: Retrograde intramedullary nailing is a good fixation system for supracondylar femur fractures with less operative time and blood loss. By closed reduction, not disturbing fracture hematoma and even in open reduction less soft tissue dissection and thus reducing complications like infection, stiffness, distal screw related local symptom is a common problem and is related to implant and technique and has a definite learning curve. Utmost aseptic precaution great care required to prevent infection. Non-requirement of bone graft decreases the morbidity. Early surgery, closed reduction, at least two screws in each fragment and early post-operative knee mobilization are essential for good union and good knee range of motion.

Management of distal femur fractures with locking compression plate: a prospective study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Distal femur fractures need to be treated operatively to achieve optimal outcomes. Different types of internal fixation devices have been used but, the number of revisions for non-union, loss of reduction and implant failure has been high.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">This prospective study reviewed 20 cases of distal femoral fractures surgically managed with distal femoral locking compression plate between December 2013 and December 2015 at Mediciti Institute of medical sciences, Ghanpur, Medchal, tertiary care referral and trauma centre. Fractures were categorized according to OTA classification by Muller</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Highest number of patients was in their 3rd decade (25%) 18 out of 20 patients had closed injury. Type A2 Muller’s fracture was the most common fracture type 7 out of 20 patients (35%).The mean follow up period in this study was 8 months. The average range of knee flexion achieved was about 109°. The mean score 81.75 points were rated using Neer’s functional score (Max 100). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The locking compression plate is the treatment of choice in the management of comminuted distal femoral fractures especially Type A fractures where we have found higher Neer scores. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is valuable in the management of these fractures.</span></p><p class="Default"> </p>

Outcomes of Surgical Management of Distal Femur Fracture with Distal Femoral Locking Compression Plate at Koshi Zonal Hospital

Introduction: Distal femoral fractures comprise 4-6% of all femur fractures. The management of distal femur fractures are challenging because of significant morbidity and complication rate even with advanced surgical techniques and implants. Open reduction and internal fixation (ORIF) with pre-contoured distal femoral locking compression plate (DF-LCP) is one of the most acceptable surgical procedures these days.Objectiv: Evaluation of functional outcomes of distal femur fractures managed surgically using DF-LCP at Koshi Zonal Hospital.Methodology: In this cross sectional study 21 patients having closed distal femur fractures with or without intra-articular extension to femoral condyle fixed with DF-LCP at Koshi Zonal Hospital, Nepal from March 2016 to March 2017 were included. Patients with open fracture, severe comminuted fracture, and neurovascular impairment were excluded. These patients were followed-up for up to one year and we recorded the knee range of motion, full weight bearing time fracture union time, and complications. We used Neers' functional scoring system to evaluate the final outcomes and data was analysed using Microsoft Excel Programe.Results: Out of the 21 patients of distal femur fractures, 16 were diametaphyseal distal femur fractures and five were supracondylar fractures with intra-articular extension. Mean age recorded was 45 (range 19-75) years, hospital stay mean duration 12 (range 10-19) days and duration of surgery 85 (range 60-150) minutes, full weight bearing walking time mean 16 (range 12-22) weeks, radiological union time mean 20 (range 17-29) weeks and Neers' score was excellent in 66.66%, satisfactory in 23.80%, unsatisfactory in 4.76%, and poor in 4.76%.None of our patients had complications like; loss of fixation, implant failure or post-operative neurovascular injury.Conclusion: Distal Femoral Locking Plate is one of the best implant to be used as fixation method for both extra-articular and intraarticular distal femur fracture.Birat Journal of Health SciencesVol.2/No.3/Issue 4/Sep- Dec 2017, Page: 260-265

Functional outcome of distal femoral fractures treated with DF-LCP [Distal femur locking compression plate

Introduction: Management of distal femoral fractures is a therapeutic challenge to the orthopaedic and due to its extensive soft tissue injuries, bone loss, comminution, articular extension, instability and usually treated surgically. There is no single implant that can be used for all distal femoral fractures. The introduction of DF-LCP is a welcome change that has brought a drastic change in management of these fractures. Aim: To evaluate the functional outcome of Distal femoral fractures treated with DF-LCP Materials and Methods: This prospective study was carried out at orthopaedics department of a tertiary care teaching hospital of Southern Rajasthan from June 2013 to December 2015. A total 34 patients of AO Type A and Type C distal femur fractures were included in the study. The method used for fixation was closed or open reduction and internal fixation with DF-LCP. All the patients were followed up for a period of one year and functional outcome was assessed according to Neer’s score system. Results: On evaluation according to Neer’s criteria mean score were 87 with a range of 62-97. Out of 34 patients 21(62%) had excellent, 11(32%) satisfactory and 2(6%) unsatisfactory result. Conclusion: We conclude that DF-LCP is a safe and reliable implant for distal femoral fractures AO Type A and Type C. However careful understanding of basic principles and identification of appropriate fracture pattern for use of DF-LCP are essential to avoid complications and to produce excellent result.

A study of long term functional outcome of surgical management of distal femur fractures in adults using locking compression plate in Indian rural set up

Objective: To study and analyze the effectiveness of the surgery of the distal femur fractures using Locking Compression Plate based on fracture union, complications, recovery, return to work and overall functional outcome using Neer’s criteria. Introduction: Due to rapid industrialization and growth of the automobile industry, there is increase in the road traffic accidents. Most of the high velocity injuries are associated with fractures occurring at the distal end of the femur. In view of these potential complications and complexity of the injuries at the distal end of femur, many surgeons agree that large numbers of distal femur fractures are to be managed surgically for better functional outcome and lesser complications. • Internal fixation by using Locking Compression Plates (LCP) is one of the commonly performed surgeries for injuries around the knee because it gives better results in terms of recovery, fracture union, return to work and overall functional outcome • LCP is a single beam construct where its strength of fixation is equal to sum of all screw-bone interfaces. Its biomechanics works on splinting rather than compression giving a flexible stabilization. furthermore, when applied via a minimally invasive technique, provides prompt healing and less bone resorption due to better preservation of blood supply • This study will be helpful in understanding and analyzing the benefits and disadvantages of treating the fractures of the distal end of the femur in adults using Locking Compression Plate and functional outcomes of the surgical procedures Methodology: A group of 40 distal femur fracture patients, treated with open reduction and internal fixation using Locking Compression Plate (LCP) between Feb 2015 to August 2016.Results: Out of 40 patients excellent results seen in 23 patients (57.5%), good results seen in 10 patients (25%), fair results seen in 3 patients (7.5%), and poor results seen in 4 patients (10%) using Neer’s scoring system

Clinical and functional outcomes of surgical management of distal femur fractures using distal femur locking compression plate

Distal femur fractures are reported to be less than 1% of all fractures and between 4 to 6 percent of all femoral fractures. Knowledge of anatomy of articular block with trapezoidal shape on axial section and anterior bowing of femur shaft is critical for operative treatment of distal femur fractures. In this prospective study, distal femoral locking compression plate was used for surgical management of these fractures to evaluate the clinico-radiologic and functional outcomes. 40 patients having 41 distal femur fractures were managed with open reduction and internal fixation using distal femur locking compression plate as per standard AO technique during period of July 2014 to September 2016. Patients were followed up for a minimum of 6 months. Average time of union was 18.23 weeks. Complications seen were delayed union in 2 cases, plate bending in one case who had an episode of seizure, was reoperated & union achieved later on and implant breakage in one case. Superficial infection was seen in 2 cases. Results were found to be excellent in 70%, good in 15%, fair in 12.5% and poor in 2.5% of the patients.

Management of distal femur fractures with distal femur locking plate by MIPPO technique

Introduction: Distal femur fractures are a challenge to orthopaedic surgeons as full restoration of function is problematic and demands technical expertise. Rigid fixation, maintaining the alignment and length of the femur and early mobilisation is required to achieve good results. The study was conducted to know the outcome after fixation by distal femur locking plate by MIPPO technique. Materials and methods: A prospective study of 20 cases of distal femur fracture operated with distal femur locking plate using MIPPO technique was conducted at MVJMC & RH from June 2012 to June 2016. Patient followed up at 2, 4, 6 weeks and 3, 6, 9 months and has evaluated for fracture union, knee ROM and Knee Society Score at 6 months. Results: Total number of 20 patients with distal femur fracture was managed with distal femur locking compression plate by MIPPO technique. In all 20 patients fracture united with mean duration of 14.5 weeks. There were no cases of non-union. Mean Knee Range of Movements at 6 months was 1100 flexion and extension limitation of 100.Mean Knee Score was 87.6 and Mean Functional Score was 78. There were no cases of implant loosening or breakage. 1 case of superficial infection, no deep infection noted. Conclusion: With MIPPO technique using distal femur locking plate for distal femur fractures gives good results with rigid fixation, excellent union rates, good functional outcome and minimal complications

Management of distal femur fractures with locking compression plate

Background: Distal femur fractures are often caused by high energy trauma mainly sustained in road traffic accidents. Open injuries with considerable comminution of condyles and metaphysis are frequently seen. The present study is undertaken to assess outcome of 20 patients of distal femur fractures treated with locking compression plate. Methods: 20 cases of distal femur fractures in adults treated by locking compression plate were studied. Of the 20 ‘lower end of Femur’ fractures, 4 were Mullers type A3; 2 were Mullers type B1; 6 were Mullers type C1; 4 were Mullers type C2 and remaining 4 were Mullers type C3. All fractures were closed. Maximum age was 68 years and minimum age was 26 years. 16 were male and 4 were female. Results assessed by time for union, range of motion of knee, shortning, varus/valgus deformity and complications.fuctional assessment was done by Neers scoring. Result: Most common type of distal femur fracture was Mullers type C1. Of 20 patients, 17 patients (85%) showed radiological union within 18 weeks. Average flexion in this study was 105 degree with more than 65% patients having knee range of motion more than 110 degree. Average extensor lag in this study was 5.60 degrees. 3 had shortening, 2 patients had shortening of 15 mm and 1 had shortening of 10mm.varus / valgus malalignment of less than 5 degree seen in 5 cases.4 patient developed superficial infection.only one patient went into delayed union. 80 % excellent and good results were obtained by Neers scoring. Conclusion: Locking compression plate is an optimal tool for supracondylar fractures of femur. It provides rigid fixation in region of femur, where a widening canal, thin cortices and frequently poor bone stock make fixation difficult. Surgical exposure for plate placement requires significantly less periosteal stripping and soft tissue exposure than that of normal plates.

A study of surgical management of distal femoral fractures in adults using locking compression plate

<p class="abstract"><strong>Background:</strong> The introduction of locking compression plates with option of locked screws has provided the means to increase the stability of fracture fixation.</p><p class="abstract"><strong>Methods:</strong> In this study, 30 distal femoral fractures were treated using the distal femoral locking compression plate. All fractures were fresh, closed and operated within 12 days. Follow up duration ranged from 6 to 18 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, 20 patients were males and 10 were females. The 23 of the fractures (76.66%), were caused by road traffic accidents, 3 were due to accidental falls (10%), one was due to assault and 3 were due to fall from height.9 patients had associated injuries. All patients were treated with open reduction and internal fixation using Locking Compression Plate. 6 to 9 holed plates were used. Out of 30 patients 2 went for delayed union and 3 went for non-union. Average knee flexion was 109<sup>o</sup> having knee range of motion more than 100 with 50% patients. Average knee extensor lag was 2.4 degrees with only 4 patients with lag more than 5. 2 patients developed 2 cm shortening. 4 patients had less than 5 degrees of malalignment. 2 patients had deep infection. Functional outcome was measured using NEER's scoring system and was done at the end of 5- 7 months (average of 6 months). Excellent results- 17 (56.66%) good results-8 (26.66%) fair results-2 (6.66%) poor results-3 (10%).</p><p><strong>Conclusions:</strong> LCP condylar plate represents an evolutionary approach to the surgical management and is an important armamentarium in distal femur fracture fixation, especially when fracture is severely comminuted and in situations of osteoporosis. </p>

Extra Articular Supracondylar Femur Fractures Managed with Locked Distal Femoral Plate or Supracondylar Nailing: A Comparative Outcome Study.

Despite recent evolution in the operating techniques and surgical implants, debate continues around the choice of implant for management of distal femur fractures. High rates of complications and union difficulties continues to make them a momentous therapeutic challenge. To compare the outcome of locked compressive plating versus retrograde nailing in the management of extra articular supracondylar femur fractures. In this randomized prospective study, 42 patients with extra-articular distal femur fractures were segregated into two groups based on internal fixation with distal femoral locking plate (n=22) and retrograde nail (n=20). Clinical and radiological parameters were studied and functional evaluation was done at 18 months with KSS score. A significant difference in terms of mean duration of surgery and intraoperative blood loss was discerned in favour of plating group although complication rates were equivalent between the groups. Mean duration until union was 26.5 weeks (SD=12.9; range 12 to 64 weeks) in the locked plating and 22.6 weeks (SD=13.1: range 12 to 60 weeks) in the retrograde nail group. The difference came out to be statistically insignificant. Fractures in nailed patients united earlier but the difference was not statistically significant with similar overall union rates. Functional scores too were comparable between them. We deduce that surgical planning and expertise rather than the choice of implant are more crucial for optimal results. Nailing proved more cumbersome intraoperatively due to escalated operating time and blood loss and successive anterior knee pain necessitating implant removal but this detriment may be offset by an inclination towards earlier union. With Less Invasive Stabilization System (LISS), technical errors are more common and less forgiving and must be overcome with proper preoperative planning and intraoperative attention to detail.

Treatment Options for Distal Femur Fractures.

Despite advances in implant design, the management of distal femur fractures remains challenging. Fracture comminution and intra-articular extension can make it difficult to obtain an adequate reduction while preserving the soft tissue attachments to bone fragments to allow for bone healing. Many implant manufacturers have developed optimal anatomically contoured, distal femoral locking plates with percutaneous guides. This environment allows for the application of lateral locked plates in a biologically friendly manner. Although initial reports had high success rates, more recently a high rate of nonunion has been found, particularly in elderly patients. Limited literature is available for the treatment of patients with osteoporotic bone and associated ipsilateral total knee replacement and hip replacement. We present a patient with a distal femur fracture with significant comminution in the setting of an ipsilateral total hip replacement.

Open Reduction vs Distal Femoral Replacement Arthroplasty for Comminuted Distal Femur Fractures in the Patients 70 Years and Older

BackgroundThe ideal management of distal femur fractures in the elderly is unclear. Acute arthroplasty has the theoretical advantage of earlier mobilization. We examined the outcomes of patients 70 years and older who underwent open reduction internal fixation (ORIF) vs distal femoral replacement (DFR) for comminuted, intra-articular distal femur fractures. MethodsA retrospective review of patients with AO/OTA classification 33C distal femur fractures treated with either ORIF or DFR was performed. Outcomes including all-cause reoperation, length of stay, fracture union, postoperative complications, use of ambulatory device and living situation at 1 year, and mortality were evaluated. ResultsThe study cohort included 38 patients: 10 underwent DFR and 28 ORIF. Mean patient age for both cohorts was 82 years. No difference in comorbidities or mechanism of injury was found between groups. The incidence of reoperation was 11% in the ORIF group and 10% in the DFR group. In the ORIF group, the average time to fracture union was 24 weeks, with a nonunion incidence of 18%. Twenty-three percent of ORIF group were wheelchair dependent vs none in the DFR cohort, although not statistically significant. Differences between the groups with respect to all-cause reoperation, living situation or need for ambulatory device at 1 year, and 1-year mortality did not reach statistical significance. ConclusionNearly 1 in 5 patients older than 70 years developed a nonunion after ORIF of an intra-articular distal femur fracture. At 1-year follow-up, all patients in DFR group were ambulatory while 1 in 4 in the ORIF group were wheelchair bound.