Outcome Of Distal Femoral Fractures Research Articles

Functional Outcome of Distal Femoral Fractures using NEER Scoring Managed by Distal Femoral Locking Plate versus Retrograde Intramedullary Nail: A Cross-sectional Study

Introduction: Distal femur fractures are a group of fractures that have been a topic of debate for the past decade, were traditionally treated mainly using conservative methods. However, with advancements in surgical techniques and implants, operative intervention has now become the preferred treatment approach. There are various methods for treating distal femur fractures and the present study compares the treatment of distal femoral fracture using distal femur nailing versus the use of locking plate. Aim: To compare the functional outcomes of stabilising distal femur fractures using locking compression plating versus retrograde nailing and to evaluate the merits and drawbacks of each procedure. Materials and Methods: A cross-sectional comparative study was conducted in the Department of Orthopaedics at Calcutta National Medical College and Hospital, Kolkata, West Bengal, India, over a one-year period from (January 2021 to January 2022. Total 46 patients with distal femur fractures were included, with six lost to follow-up. Two groups were divided in which total 20 patients underwent distal femoral nailing, while 20 were treated with distal femoral locking plates. Functional outcomes were assessed using the NEER Score, aiming for perfect restoration of the articular surface, stable fixation, full knee range of motion, and good functional results. Data were entered into a Microsoft Excel spreadsheet for statistical analysis using Statistical Packages for Social Sciences (SPSS) (version 27.0; SPSS Inc., Chicago, IL, USA). Numerical variables were summarised as mean and standard deviation, while categorical variables were presented as counts and percentages. A p-value of ≤0.05 was considered statistically significant. Results: The study population consisted of 70% males with a mean age of approximately 55 years. Road traffic accidents were the most common mode of injury. The mean time for radiological union in the nailing group was 14.05 weeks, significantly shorter than the 16 weeks in the plating group. The mean range of knee flexion was 111° in the nailing group and 114.5° in the plating group. The average NEER score was 84.10 for the plating group and 83.30 for the nailing group. There was no statistically significant difference in functional outcomes between the two groups. Conclusion: Both retrograde intramedullary nailing and the use of locking compression plates can be considered as suitable treatment options. Early weight-bearing can be initiated with retrograde nailing. No significant difference was observed in terms of outcome, fracture healing, or NEER score. The time taken for radiological union of fractures using both techniques was comparable. Proper operative planning, execution, and adherence to a strict rehabilitation protocol play crucial roles in the overall patient outcome.

Plating for Intra-articular Fractures of the Distal Femur: Functional and Radiological Outcomes.

Background and objective Intra-articular fractures of the distal femur pose a significant surgical difficulty. These fractures are challenging to repair, and surgery is frequently advised for a successful outcome. The distal femoral fractures make up between 4-6% of all femoral fractures and account for less than 1% of all fractures. When compared to the single screw's axial stiffness or pullout resistance, as is the case with unlocked plates, the locking compression plate (LCP) is a single beam construct whose strength of fixation is equal to the sum of all screw-bone contacts. Against this backdrop, the current study was conducted for evaluating the functional outcomes of distal femoral fractures treated with LCP fixation. Methodology We conducted an observational study at a tertiary care facility in Kolar spanning a period of three years, from January 2019 to January 2022. We included all patients aged more than 18 years, who were diagnosed with distal femoral fractures [only those classified as type C according to theAOFoundation/Orthopedic Trauma Association (AO/OTA) classification]. Patients with terminal illnesses, revision of previous surgery, fractures with neurovascular injuries, and those diagnosed with pathological fractures were excluded from the study. The included patients were treated by LCP and discharged on postoperative day 10 after suture removal. The first follow-up was at the first month and subsequent follow-ups were done at threeand six months, and the functional outcomes were assessed by using Neer's score for straight leg raises. Radiographs with fading fracture lines and callus formation onthree-fourthsof the cortices were regarded as indicators of fracture healing. Results Among the 30 study participants,80% were males. The mean time for the radiological union was 15 weeks. In this study, there were no instances of infection or angular deformity greater than 5 degrees. About 80% of the study participants had ranges of motion (ROM) above 120 degrees at the end of the six-month follow-up period; 12 cases had an excellent score (40%), 15 cases (50%) had a satisfactory score, two cases (6.7%) had an unsatisfactory score, and only one case had poor score. Common complications observed were excessive bleeding, difficulty in reduction, superficial infections, and knee stiffness. Conclusion For patients with distal femoral fractures, the LCP treatment can result in good functional and radiological outcomes with fewer complications.

Short Term Analysis of the Functional and Radiological Outcome of Distal Femoral Fractures Fixed with Locking Compression Plate by Minimally Invasive Plate Osteosynthesis (MIPO) Technique

Background: Fractures of distal femur are very complex injuries and there is significant difficulty to manage. These injuries are severe and have a potential to produce long term disability. These fractures often are unstable and comminuted and tend to occur in elderly or multiply-injured patients. The fractures of distal femur account for 7% of all femoral fractures. If Hip fractures are excluded, 31% of fractures involve the distal femur. The fractures involving distal 15 cm of femur including distal femoral metaphysis (supracondylar) and articular surface (intercondylar) are classified as distal femur fractures [1]. Distal femur fractures exhibits bimodal age distribution. In young adults it occurs due to high velocity trauma like road traffic accidents. These patients often sustain multiple and compound injuries. Older patients sustain distal femur fractures mostly due to trivial fall occurring in elderly osteoporotic bone. In 1960’s most of these fractures were treated conservatively and documented better outcome than operative treatment. But with the advent of newer implants and modern techniques, these fractures are best treated with surgical stabilization. The newer modalities of treatment include minimally invasive plate osteosynthesis (MIPO) and Less invasive skeletal stabilization (LISS). Aim of this study: To evaluate twenty cases of distal femur fractures fixed with locking compression plate by minimally invasive plate osteosynthesis (MIPO) technique in the Department of Orthopaedic Surgery at SCB Medical College and Hospital, Odisha between July 2018 to November 2020. To prospectively analyse the clinical and radiological outcome of the above procedure. Keywords: Minimally Invasive Plate Osteosynthesis (MIPO), Distal Femoral Fractures, Radiological Outcome, Locking Compression Plate

A prospective study on functional and radiological outcome of distal femur fracture treated with distal femur locking compression plate (DF-LCP) in adults

Introduction: Distal femur fractures are one of the most fractures encountered by orthopaedic surgeons in routine practice. These fractures pose therapeutic challenges of fracture treatment because they are usually compound, comminuted, readily deformed because of muscle forces acting on the distal fragment, prone to result in functional impairment of the knee joint because of the injury to quadriceps system. 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 due to its contouring to the distal femur with combiholes in proximal pattern.Aim: Evaluation of the functional and radiological 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 January 2019 to June 2020. A total 30 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 at the end of 6 months and functional outcome was assessed according to Knee Society Scoring System.Results: Fracture union was seen in all patients. On evaluation according to Knee’s criteria mean score were 73.76. Out of 30 patients excellent in 19 patients (63.33%), good in 09(26.67%), fair in 02(6.67%) and poor in 01(3.33%).Conclusion: DF-LCP is effective and reliable implant in treating distal femoral fractures AO type A and type C with minimal complications. However careful understanding of basic principles and identification of appropriate fracture pattern are essential to produce excellent result.

Functional outcome of distal femoral fractures managed surgically using locking compression plate laterally and augmented with titanium elastic nail system medially

Background: Distal femur fractures are generally due to high velocity trauma particularly form road traffic accidents and fall from height. The treatment of distal femur fractures has evolved from conservative to operative to fixation of both lateral and medial columns of femur.
 Aims and Objective: The aim of this study was to evaluate the functional outcome of operated cases of comminuted fracture of lower end of femur fixed with locking compression plate laterally and augmented with titanium elastic nail system medially.
 Materials and Methods: The present study was a prospective study carried out in Bharati Vidyapeeth Medical College and Hospital, Sangli after approval from institutional ethical committee. In this study, 20 patients with communited fracture of lower end of femur were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and clinical examination was done in all cases. After preanesthetic evaluation and relevant investigations patients were treated by reduction (close or open) and fixation was done by locking compression plate laterally and augmented with titanium elastic nail system medially. Patients were followed up at 6, 10 and 14 weeks for functional outcome by Neer’s scoring system and degree of flexion at knee joint.
 Results: Out of 20 studied cases there were 16 (80%) males and 4 (20%) were females with a M:F ratio of 4:1. The mean age of male patients was found to be 42.81+/-14.79 whereas mean age of female patients was 40.5 +/- 14.36. The mean age of male and female patients was found to be comparable with no statistically significant difference (P=0.78). Most of the patient were diagnosed with the fracture of AO TYPE C3 (7 cases), followed by AO TYPE C1 (4 cases). Full weight bearing was achieved in 8 (40%) patients within 18 weeks whereas remaining 12 (60%) patients required more than 20 weeks for full weight bearing. 14 (70%) patients had excellent outcome whereas, Good, Fair and poor outcomes were seen in 4 (20%), 1 (5%) and 1 (5%) patient. On one-way ANOVA analysis, showed that the flexion was significantly higher in 12 weeks as that of the 6 weeks (P =<0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =<0.0001).
 Conclusion: Our study found that locking compression plating laterally augmented with titanium elastic nail system medially for comminuted distal femoral fractures is a good fixation system and provides good angular stability.

Outcomes of distal femoral fractures treated with dynamic condylar screw (DCS) plate system: a single centre experience spanning 15 years.

Introductionthe dynamic condylar screw (DCS) plate is an angular stable fixation (95°) system for distal femur fractures that allows for the ability to apply compression across the femoral condyles. The aim of this study was to evaluate our experience treating distal femur fractures with this device and give the long-term outcome.Methodsa retrospective study was undertaken in our institution during the period from January 2002 to December 2016. A total number of 240 patients with distal femur fractures were managed using DCS plate system and included in the study. The mean follow-up period was 33 months (26 - 62 months). Clinico-radiological progression of fracture union as well as the functional outcome was studied.Resultsmost of the fractures were closed injuries in young male patients resulting from traffic accidents. The average time to union was 12.6 weeks (range 11 - 23). Eight patients (3.3%) suffered superficial infection. Five patients (2.1%) developed deep venous thrombosis. Delayed union was observed in nine cases (3.7%) and non union in six cases (2.5%). At final follow-up, the mean range of motion (ROM) of knee was 115.7° (100°-148°). The mean Knee Society Score (KSS) was 84.5 (59 - 94) and the mean Lysholm score was 88.6 (range, 61 - 96), translating to good clinical results.Conclusionour study conclusively establishes that excellent functional outcome can be achieved with DCS plate inserted with skilled surgical technique in distal femur fractures including the ones that are communited or occurring in osteoporotic bone with a negligible complication rates.

Study of surgical management of distal femur fracture using locking compression plate

Introduction: Distal femur fracture are being treated with distal femur nail, dynamic condylar screw and even addition of a medial plate with good clinical results. By this study, we explore the potenti ability of a distal femur locking plate to counter distal femur fractures of extra articular, partial or intra- articular nature. Positive results have been brought out by various groups from all over the world. Aim: To study the clinical, functional and radiological outcome of distal femoral fractures managed by open reduction and internal fixation with distal femur locking plate in skeletally mature patients. Materials and Methods: This was a prospective study conducted from January 2018 to January 2021 at the Government Medical College Khandwa with a 6month follow-up in skeletally mature patients with post-traumatic distal femur fractures were included. Follow and evaluation was done according to the Neer scoring system. The statistical data analysis was carried out using SPSS version 20 (IBM, Chicago, USA). The p-value

A study on functional outcome of distal femoral fractures with distal femur locking compression plate

Background: Historically it is difficult to treat intercondylar and supracondylar distal femur fractures. The aim of this study is to assess the clinical and radiological functional outcome of distal femoral both extraarticular and intraarticular fractures types(A,B,C) treated with locking compression plate. Material and Methods: We reviewed 30 distal femoral fractures treated with distal femoral locking compression plates between 2018 to 2019. There were 20 male and 10 female with mean age of 48 yrs(range 21 – 70). More patients were of type A2 (AO classification) and had been caused by high energy trauma. Results: out of 30 patients, 11 had excellent, 13 had good and 6 had fair outcome. 6 patients had limb length discrepancy and 10 patients had extension lag. Three patient had valgus deformity and three patients had varus deformity. Conclusion: It provides better fixation of fracture in elderly patient with osteoporosis. Post operative early passive mobilisation of the knee gives good range of motion. Operative time is lessened as the locking compression is pre contoured and does not require anatomical fracture reduction.

Clinical and radiological outcome of distal femoral fractures treated by distal femoral locking compression plate

<p class="abstract"><strong>Background:</strong> Distal femoral fractures represent a challenging problem in orthopaedic practice. Open reduction with internal fixation has replaced previous trends of closed conservative management and external fixation. Distal femoral locking compression plate (DF-LCP) provides both locking and compression screw fixation of the femur shaft. This study was conducted to assess the clinical and radiological results of distal femoral fractures treated with DF-LCP.</p><p class="abstract"><strong>Methods:</strong> It was a prospective study on<strong> </strong>90 cases. Fracture patterns AO type A and C were considered. Lateral approach was used as standard surgical technique. The total follow up period was 6 months .Functional and radiological results were evaluated using Neer’s score.<strong></strong></p><p class="abstract"><strong>Results:</strong> The series consisted of 64 males and 26 female patients with mean age 40.56 years. Road traffic Accident (68%) was the commonest mode of injury. Most were closed fractures. Wound infection was seen in 4 patients. Average flexion at knee joint was 117<sup>°</sup>. 100% union rate was observed with an average union time of 14.3 weeks. NEER’s score was excellent in 44, good in 32, fair in 10 cases and poor in 4 cases.</p><p class="abstract"><strong>Conclusions:</strong> DF-LCP is an important armamentarium in treatment of distal femur fractures especially when fracture is closed, severely comminuted and in case of osteoporosis.</p>

Outcomes of distal femoral fractures treated with minimally invasive plate osteosynthesis versus open reduction internal fixation with combined locking plate and interfragmentary screws

PurposeFractures of the distal femur remain challenging to treat, and numerous fixation methods are designed to promote stability and fracture healing. Locking plate constructs have recently become the mainstream fixation method, but debate exists on whether to use locking plates alone or to augment them with interfragmentary screws. This article compares outcomes of distal femur fractures treated with a single locking plate alone versus those treated with a locking plate and interfragmentary screws. MethodsWe retrospectively reviewed 57 patients treated for distal femur fractures from 2010 to 2013. Patients were divided into two groups: Those treated with a locking plate alone utilizing the minimally invasive plate osteosynthesis (MIPO) technique and those treated with combination of a locking plate and interfragmentary screws using an open technique. Postoperative outcomes were obtained via a manual chart review. Fracture healing and callus indices were evaluated from radiographs. Results9 patients required revision surgery in the locking plate alone group (6 for persistent nonunion and 3 for varus deformity). Only two patients in the combination group required revisions (both for nonunion). Average time to full weight bearing was 19.54 weeks in the locking plate group versus 14.57 weeks in the combination group (p = 0.004). At the time of full weight bearing, frontal (1.15 versus 1.11, p = 0.004) and sagittal (1.22 versus 1.15, P = 0.008) callus indices were both significantly greater in the locking plate group. ConclusionsIn this study, the combination of a locking plate and interfragmentary screws achieved suitable stability and a faster time to full weight bearing than using a locking plate alone. Surgeons should consider combining a locking plate with interfragmentary screws as an effective method for fixation of distal femur fractures, particularly in cases when plate fixation alone fails to provide adequate fracture stability.

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.

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.

Outcome of distal femoral fractures treated with locking compression plates

<p class="abstract"><strong>Background:</strong> Fixation of distal femoral fractures with a lateral plate alone is associated with nonunion and/or malunion with varus collapse. Locking compression plates may reduce the tendency of varus collapse. Hence, we evaluated the union rates and functional and anatomical outcome in patients of distal femoral fractures who were treated with locking compression plates.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted at a tertiary health care center at Bangalore between July 2010 and June 2012. Patients with distal femoral fractures were treated with locking compression plates and were followed up for at least 6 months. Outcomes were evaluated using Neer’s score to assess outcomes in adult distal femoral fractures.<strong></strong></p><p class="abstract"><strong>Results:</strong> The study included 22 patients (10 males and 11 females) among whom one patient was lost to follow up within 6 months after the procedure. All the fractures were post-traumatic. Nineteen (91%) patients had closed fractures whereas two (9%) had open fractures. Muller’s A1 type was the most common (n=7) type of fracture followed by C2, C1, A2 (n=4 each) and B1, A3 (n= 1 each). Median duration of follow-up was 8 months (range: 6-18 months). The mean NEER’s functional score was 80 points. Overall results were excellent in 5 (24%) out of 21 cases and were satisfactory in 15 (71%) cases and only one had an unsatisfactory result.</p><p class="Style14"><strong>Conclusions:</strong> Locking compression plates offer excellent-satisfactory outcome in patients with distal femoral fractures. </p>

Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures.

Good results have been published by researchers with distal femur nail, dynamic condylar screw and even addition of a medial plate to a distal femur locking plate for treating distal femur fractures. By this study, we explore the capability of a distal femur locking plate to counter distal femur fractures of extra- articular, partial or intra- articular nature. Positive results have been published by various groups from all over the world. To study the functional and radiological outcome of distal femoral fractures in skeletally mature patients treated by open reduction and internal fixation with distal femur locking plate. This was a prospective study conducted from January 2012 to March 2014 at the Government Medical College and Hospital (GMCH) with a 2 year follow-up. Twenty five skeletally mature patients with post-traumatic distal femur fractures were included. Patients with open grade 3B and 3C distal femur fractures, according to the Gustilo- Anderson classification and pathological distal femur fractures were excluded from the study. Patients with any fracture other than the distal femur in the ipsilateral limb were excluded from the study. Follow-up at 3 months, 6 months, 1 year and 2 years was carried out and evaluation was done according to the Neer scoring system. The statistical data analysis was carried out using SPSS version 20 (IBM, Chicago, USA). The p-value <0.05 was considered significant. Following all principles of fracture reduction, union was achieved in all patients with mean time to radiological union being 19 weeks. The mean Range of Motion (ROM) was 109 degrees with 20 patients having a Neer score graded as excellent to satisfactory. Our study had nine cases which required additional surgeries. Out of these, all nine cases required bone grafting, three also required antibiotic cement bead insertion initially. Three patients developed complications in the form of infection (two cases) and mal-union (one case) during the course of our study, but were completely treated by the end of the study. Positive results can be obtained by distal femur locking plate alone as it is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation and taking benefit of the mechanical properties of a locking plate.

Distal femoral fractures: The need to review the standard of care

BackgroundHip fracture care has evolved, largely due to standardisation of practice, measurement of outcomes and the introduction of the Best Practice Tariff, leading to the sustained improvements documented by the National Hip Fracture Database (NHFD). The treatment of distal femoral fractures in this population has not had the same emphasis. This study defines the epidemiology, current practice and outcomes of distal femoral fractures in four English centres. Patients and methods105 patients aged 50 years or greater with a distal femoral fracture, presenting to four UK major trauma centres between October 2010 and September 2011 were identified. Data was collected using an adapted NHFD data collection tool via retrospective case note and radiograph review. Local ethics approval was obtained. ResultsMean age was 77 years (range 50–99), with 86% female. 95% of injuries were sustained from a low energy mechanism, and 72% were classified as either 33-A1 or 33-C1. The mean Parker mobility score and Barthel Independence Index were 5.37 (0–9) and 75.5 (0–100) respectively. Operative management was performed in 84%, and 86% had their surgery within 36h. Three quarters were fixed with a peri-articuar locking plate. There was no consensus on post operative rehabilitation, but no excess of complications in the centres where weight bearing as tolerated was the standard. 45% were seen by an orthogeriatrician during their admission. Mean length of stay was 29 days. Mortality at 30 days, 6 months, and 1 year was 7%, 16% and 18% respectively. DiscussionThis study demonstrates that the distal femoral and hip fracture populations are similar, and highlights the current disparity in their management. The metrics and standards of care currently applied to hip fractures should be applied to the treatment of distal femoral fractures. Optimal operative treatment and rehabilitation remains unclear, and is in need of further research.

Clinical Outcomes of Distal Femoral Fractures in the Geriatric Population Using Locking Plates With a Minimally Invasive Approach

Fractures of the distal femur comprise 4% to 6% of all femoral fractures. Elderly patients are predisposed to low-energy fractures due to osteoporosis. Treatment of these fractures in the elderly group remains a challenge. Our hypothesis is that locking plates inserted with minimally invasive plate osteosynthesis (MIPO) techniques will produce better results compared to those inserted by open technique. The objective of this study is to evaluate the clinical outcomes of MIPO technique using locking plates in the elderly patients. A total of 24 elderly patients (mean age 73 years) with distal femur fractures treated using the MIPO technique (2007-2010) were reviewed retrospectively. Parameters analyzed included classification of fracture, time to fracture union, knee range of motion, functional knee score (Knee Society Score-Functional) at 6 months, and other significant complications. One patient was lost to follow-up. In all, 88% of the fractures were extraarticular. The mean time to union was 13.48 (range: 8-28) weeks. Mean range of motion achieved at 6 months and beyond was 100° ranging from 0 to 30 (extension) to 90 to 140 (flexion). Functional knee scores at 6 months from fixation were satisfactory (mean score 88.8). There were no cases of implant failure, nonunion, and infection. In all, 6 (25%) patients developed deep vein thrombosis (DVT) in the early postoperative period, all of which were below the level of the knee joint. Locking plates inserted using MIPO techniques in elderly patients with distal femur fractures appear to be promising based on clinical outcome measurements. However, there was a high incidence of DVT noted.

Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures

BackgroundThe aim of this prospective study was to compare the outcomes of distal femoral fractures treated by the Less Invasive Stabilization System (LISS) in multiply injured and isolated fracture cases. MethodsThis study comprised 26 patients (16 men, 10 women), who had 27 distal femoral fractures. Patients were divided into two groups; multiple injuries (group I) or isolated distal femoral fracture (group II). The average Injury Severity Score of group I was 26.7. Operations were performed according to biological fixation principles in a submuscular manner. No bone grafting was performed to enhance the healing. The cases were evaluated based on the criteria of Schatzker–Lambert and the modified Hospital for Special Surgery (HSS) scoring system. ResultsThe mean follow-up period was 25.8 months. Union was achieved in all cases. Two patients in group I required débridement procedures due to deep infection. One of them healed completely but the other did not. The average range of knee motion of groups I and II at the last control were 112.8° and 121.8°, respectively. The mean modified HSS scores were 73.9 and 79.9, respectively. There was no significant difference in the HSS scores or the range of knee motion. The time to full weight bearing was longer in group I owing to the concomitant injuries. ConclusionsWe concluded that LISS is a useful method for comminuted supracondylar fractures with multiple trauma patients as the results showed no significant differences when compared with those of patients with isolated femoral fractures.