Treatment Of Distal Femoral Fractures Research Articles

Efficacy of retrograde intramedullary femoral nailing and locking plates in the treatment of distal femoral fracture: a systematic review and meta analysis

Efficacy of retrograde intramedullary femoral nailing and locking plates in the treatment of distal femoral fracture: a systematic review and meta analysis

Distal Femur Kırıkları için Retrograd Intramedüller Çivileme Sonuçlarının Değerlendirilmesi: 3. Basamak Travma Merkezi Retrospektif Çalışması

Aim: Distal femur fractures can be treated with modern anatomic plates and nails. This study aimed to examine the clinical and radiological results of displaced distal femur fractures in adult people who had been treated with a retrograde intramedullary nail (RIN). Material and Methods: The study included all patients who underwent RIN surgery for distal femur fracture between January 2013 and April 2018 in a level 3 trauma center. Patients were divided into two groups based on fracture pattern: open fracture and closed fracture. The preoperative and postoperative clinical, radiological and functional characteristics of patients who had RIN for a distal femur fracture were analyzed. Results: Thirty patients were included in the study. 21 (70%) patients were male. The median age of the patients was 39 (range, 18-58) years. 17 (56.7%) of the affected femur were left-sided. The etiology of the fractures was traffic accident and fall in 19 (63.3%) patients and gunshot injury in 11 (36.7%) patients. Of the patients, 17 (56.7%) were closed fractures and 13 (43.3%) were open fractures. There were no significant differences between two groups related to the surgery time (p=0.086), fluoroscopy time (p=0.805), blood loss (p=0.967), and hospitalization time (p=0.967), clinical pain and function scores (p=0.341, p=0.902), and union time (p=0.385) at the postoperative period. Conclusion: RIN is a minimally invasive method that may prevent excessive blood loss and decrease the duration of surgery time. It is an effective and reliable surgical intervention that should be considered for the treatment of distal femur fractures.

A Clinical Study on the Use of Supracondylar Plate in the Treatment of Distal Femoral Fractures in Dogs

Background: The current study was undertaken to evaluate the clinical efficacy of supracondylar plate for repair of distal femoral fractures in dog. The distal extremity of femur is the greatest weight bearing area, supracondylar plate is an orthopaedic plate system that is pre-contoured to the complex shape of the lateral surface of the canine distal femur. Methods: The study was conducted on six dogs presented with femur fracture to the Department of Surgery and Radiology, CVSc., Hyderabad over a period of 6 months (2020-21). Diagnosis based on the clinical signs, orthopaedic examination and radiography. Three fractures in right hind limb and three in the left limb. In dogs weighing less than 10 kg (N=3) were stabilized using 2.7 mm supracondylar plate while in dogs weighing more than 10 kg (N=3), 3.5 mm supracondylar plates were used. Right supracondylar plates of 2.7 mm were used in one dog while left supracondylar plates of 2.7 mm were used in two dogs. Similarly, right supracondylar plates of 3.5 mm were used in two dogs and left supracondylar plate of 3.5 mm in one dog. All the three right were 8 H while two left were 8 H and one was 6 holed. All the dogs showed partial weight bearing from 1st post-operative day. Lameness grading on pre-operatively showed grade V. Post-operatively, five dogs progressed to grade I lameness on 60th post-operative day and one dog to grade III lameness by the end of 60th post-operative day and later progressed to grade I by 120th post-operative day. The mean lameness pre-operatively and on 1st day, 15th day, 30th day, 60th day post- operatively were found to be 5.00±0.00, 4.00±0.00, 2.00±0.25, 1.66±0.33, 1.3±0.30 and 1.00±0.00 respectively. Radiographs obtained on the 60th post-operative day revealed dense callus of reduced size; fracture line barely visible with corticomedullary remodelling. The radiographs obtained on the 90th post-operative day clearly shows complete formation of bone with distinct cortex and medulla. Primary bone healing with minimal callus formation was recorded in case 5. Result: The supracondylar plate was successfully used in the treatment of distal femur fractures in dogs. Its configuration permitted early return to function of dogs affected with distal femur fractures.

Evaluation of the Results of Minimally Invasive Plate Osteosynthesis Using a Locking Plate in the Treatment of Distal Femur Fractures.

IntroductionDistal femur fractures are serious injuries that can be difficult to treat, carry an unpredictable prognosis, and lead to long-term disability and morbidity. The introduction of minimally invasive plate osteosynthesis (MIPO) avoids direct exposure of the fracture site, improves fracture healing and decreases the incidence of complications. The aim of this study was to assess prospectively the early results of the treatment of supracondylar fractures of the femur using minimally invasive percutaneous osteosynthesis using a distal femoral locking plate. The study was a prospective study that included 20 adult patients who sustained distal femur fractures.Materials and methods The study was a prospective study that included 20 patients suffering from supracondylar fractures of the femur. All patients had fixation of the fracture using a distal femur locking plate (less invasive stabilization system (LISS)) in a minimally invasive technique using an anterolateral or direct lateral approach to the distal femur according to the fracture classification. The follow-up was done using the functional evaluation scale for distal femoral fractures as regards range of motion, deformation, pain, walking ability, and return to work.ResultsThe mean age was 52.80 (19-80) years. The mean body mass index of the patients was 28.50, with a range of 23-43 kg/m2. The mechanism of trauma was road traffic accidents (RTAs) in nine patients (45%) and falling from standing height in eleven patients (55%). Fractures were classified according to the Arbeitsgemeinschaft Osteosynthesefragen-Orthopedic Trauma Association (AO-OTA) classification. All patients were followed up for a period of six months and assessed in terms of knee range of motion, deformation, pain, walking ability, and return to work. The mean time of radiological union, in which bony trabeculae crossed the fracture gap, was 3.45 ± 0.79 months. The final results obtained were excellent in four patients (20%), good in nine patients (45%), fair in five patients (25%), and poor in two patients (10%). Complications encountered were knee stiffness (20%), superficial wound infection (10%), and shortening (15%).ConclusionLISS plating using the MIPO approach is useful in treating complex distal femoral fractures. Large studies from independent centers reporting long-term results are needed to further evaluate the role of LISS plating and the MIPO approach in the management of complex distal femoral fractures.

Comparison of percutaneous plate osteosynthesis and retrograde interlocking femoral nail for femur supracondyler fractures

Objectives: There is not optimal treatment option for distal femur. Implant failure, delayed union, nonunion and knee stiffness are the most common problem occur after distal femur fractures. The aim of this study is to compare clinical and radiological outcomes of the most used two techniques. Materials and Methods: Sixty-nine patients with distal femur fractures were included in this study. 45 patients (group A) undergone locked-bridge plating and 24 patients (group B) undergone RIMN. Patients were evaluated in terms of duration of union, complications, range of motion and functional results. Functional results were evaluated according to the knee range of motion and Knee Society Score. Results: There were no significant differences between the two groups in terms of demographic characteristics. While the mean union time was 7.2±2.1 months in the percutaneous plate group, it was 6.5±2 months in the RIMN group; however, there was no statistically significant difference between the study groups in terms of duration of bone healing (p=0.125). There was no statistically significant difference in the range of motion between the two groups at the last follow-up (p=0.371). There was no statistically significant difference in the Knee Society Scores between the two groups (p=0.353) too and also there was no statistically significant difference in the incidence of alignment disorders at the last follow-up between the two groups (p=0.791). Conclusion: Both percutaneous plate osteosynthesis with RIMN to treat supracondylar-intercondylar femur fractures, both groups had similar results in terms of duration of union, range of motion, and Knee Society Scores. Furthermore, there were also similar complication rates in both groups. Both techniques can be used safely in the treatment of distal femoral fractures with satisfactory outcomes. Keywords: Distal femur fractures, Percutaneous plate osteosynthesis, Intramedullary nail

A modified anterolateral swashbuckler approach for distal femoral fractures: description and outcomes.

Background:The treatment of distal femur fractures represents a challenging task. General and local factors, including bone quality, articular surface involvement, fracture comminution, associated soft tissue injuries and ultimately fixation system, all play a role in the final clinical outcome. Current surgical approaches often undermine patellar vascularization and integrity of the extensor apparatus, not guaranteeing sufficient visualization of the medial condyle. This technical note presents the efficacy and safety of a new surgical technique to address distal femoral fractures.Methods:The original “swashbuckler” surgical approach was modified in order to obtain a better visualization of the lateral and medial femoral condyles without affecting the knee extensor mechanism and the anastomotic arterial supply of the patella. This modified surgical approach was utilized in a consecutive series of patients presenting with a AO Foundation/Orthopaedic Trauma Association (AO/OTA) 33 distal femur or periprosthetic fracture of the knee. The last follow-up functional outcome was recorded according to Sanders scoring system.Results:Twelve patients with a mean age of 67, 8 years were included in this series. The same, modified “swashbuckler” surgical approach was applied in all cases. Multiple internal fixation techniques, including a single lateral plate, a combination of a lateral and medial plate, a single lateral plate associated with lag screws, were used to obtain a satisfactory stabilization of the fracture site. All patients were reviewed at a minimum one-year follow up (median 15 months): all patients returned to their previous life style or work activity; average Sanders Score was 34.9. No major intraoperative or postoperative complications were recorded.Conclusions:The modified swashbuckler approach allows anatomical reduction and appropriate fixation with a theoretically reduced severance of the blood supply to the patella and preserves the integrity of extensor mechanism. (www.actabiomedica.it)

Cost-effectiveness of fixation versus arthroplasty for geriatric distal femur fractures

IntroductionGeriatric distal femur fractures are challenging to treat. The high mortality rate associated with a loss of mobility in this population has led some authors to compare distal femur fractures to femoral neck fractures with respect to the importance of rapidly regaining mobility in the geriatric population. Acute distal femur replacement has been advocated by some as a preferred treatment over internal fixation because arthroplasty may facilitate a more rapid return to a patient's baseline mobility level. The purpose of this study was to systematically review the literature on the costs and outcomes of fixation and arthroplasty in the geriatric distal femur fracture population and to employ decision modeling techniques to generate evidence-based treatment recommendations. MethodsA systematic literature review of clinical studies published since 2000 was conducted to synthesize the available data on outcomes, reoperation rates, and mortality rates after fixation or arthroplasty for distal femur fractures in patients with an average age greater than 70 years. A Markov decision analysis model was created. Costs, health state utilities, reoperation rates, and mortality rates were derived from the systematic literature review and publicly available data. The model was analyzed via probabilistic statistical analysis as well as sensitivity analyses with a willingness-to-pay threshold set at $100,000 per QALY and a 5-year time horizon. ResultsFrom a US societal perspective, fixation was associated with a greater quality of life benefit (2.44 QALYs vs. 2.34 QALYs) and lower cost ($25,556 vs. $65,536) compared with distal femur replacement for geriatric distal femur fractures. Probabilistic analysis demonstrated that 82 in 100 model outcomes favored fixation over arthroplasty and 18 in 100 model outcomes favored distal femur replacement. Sensitivity analyses demonstrated that this result was robust to small deviations in the cost and functional outcome variables in the model. ConclusionCompared to distal femur replacement, ORIF is likely to be a more cost-effective treatment for distal femur fractures in the geriatric patient population, though this recommendation is tempered by the relatively low quality of evidence available on the comparative functional outcomes of these treatments.

Is retrograde nailing superior to lateral locked plating for complete articular distal femur fractures?

IntroductionNonunion rates for distal femur fractures treated with lateral locked plating (LLP) remains as high as 18–22% despite significant advances with implant design and construct modulation. However, whether treatment of distal femur fractures with rIMN has improved outcomes compared to LLP has not been well characterized. The purpose of this study was to compare outcomes of complete articular distal femur fractures (AO/OTA 33-C) treated with either LLP or rIMN. Methods106 distal femur fractures in 106 patients between January 2014 and January 2018 were identified. Medical records were reviewed to collect patient age, gender, body mass index, sagittal and coronal plane alignment on immediate postoperative radiographs, time to union, incidence of nonunion, and incidence of secondary operative procedures for repair of a nonunion. ResultsOf 106 patients, 50 underwent rIMN and 56 underwent LLP. The mean age at the time of injury was 51 years (21 to 86 years) and there were 55 males. Average coronal alignment of 83.7° of anatomic lateral distal femoral angle (aLDFA) and sagittal alignment of <1° of apex anterior angulation in the rIMN group. In the LLP group there was an average of 87.9° of aLDFA and 1.9° of apex anterior angulation (p = .005 and p = .36). Average time to union in the rIMN group was 6 months and 6.6 months in the LLP group (p = .52). Incidence of nonunion in the rIMN group was 11.8% and 27.5% in the LLP group (p = .008). There were 8 secondary procedures for nonunion in the rIMN group and 18 in the LLP group (p = .43). ConclusionsOur results demonstrated a higher nonunion rate and coronal plane malalignment with LLP compared to rIMN. While prospective data is required, rIMN does appear to be an appropriate treatment for complete articular distal femur fractures with a potentially decreased rate of nonunion .

Distal femoral fractures: A comparison between single lateral plate fixation and a combined femoral nail and plate fixation

ObjectivesDistal femoral fractures occur in patients with osteoporotic bone and also as a consequence of high energy trauma. The recognised treatment options include closed or open reduction of the fracture and fixation using a locking plate or a femoral nail. Both these fixation modalities have some drawbacks. There is a risk of metalwork failure with single lateral locking plates and limited distal fixation with intramedullary nails. Since January 2018, we started using augmented fixation of distal femoral fractures using a combination of a retrograde femoral nail and a lateral locking plate. This study compares the outcomes of single lateral femoral plating (SLP) and combined nail-plate fixation (NPF). MethodsThis is a single centre retrospective case control study including all patients who sustained distal femoral fractures (OTA 33-A2, 33-A3, 33-C, 33-V3B and 33-V3D) over the study period. Outcomes for SLP were compared to NPF. The principal outcome measure was fracture union. Secondary outcome measures were reoperation rate, mortality and post-operative weight bearing status. Results67 distal femoral fractures were included in the study. 19 patients had peri‑prosthetic fractures. 40 were treated by SLP, 27 were managed with NPF. 23 (58%) patients in the SLP group were given instructions to non-weight bear or Toe touch weight bear for 6 weeks post-surgery compared to 1 (4%) in the NPF group (p = 0.000004). 7 (18%) patients treated with SLP had metalwork failure due to a non-union compared to none treated with NPF (p = 0.04). 11 fractures in the SLP group failed to unite compared to no non-unions in the NPF group (p = 0.01). These differences were magnified when assessing older (>50 years old) patients. ConclusionsAugmented fixation of distal femoral fractures using a nail plate fixation provided significantly higher union and enabled early weightbearing compared to single plate fixation. We recommend nail plate fixation for the treatment of distal femoral fractures, particularly in osteoporotic fractures.

Evaluation of Results of Open Reduction and Internal Fixation (ORIF) of Fracture of Distal End of Femur with Intra-Articular Extension.

Introduction:Fractures of the distal femur account for 0.4% of all fractures. They involve about 7% of all femur fractures, with bimodal age distribution, commonly occur during high-velocity trauma of motor vehicle accidents in the younger group of patients and are frequently associated with other skeletal injuries. The treatment of distal femoral fractures has evolved from conservative treatment to more aggressive operative treatment. The aim is to achieve and maintain a good reduction of the joint to allow early active mobilisation, thus minimising the joint stiffness and severe muscular atrophy encountered in the conservative treatment.Materials and methods:This is a retrospective study of 25 patients with distal femur fracture with intra-articular extension treated with open reduction and internal fixation with DFLP, admitted at our institute between 2016 to 2019, with a minimum follow-up of six months.Results:In our study, 19 (76%) patients had excellent to good results. Three (12%) patients had fair outcomes, and three (12%) patients had poor outcomes according to Neer’s score. The average time for bone union in closed fractures was earlier (4.25 months) than open fractures, averaging 5.86 months. The outcome was almost similar between closed and open fractures. There were 2 (8%) cases of infection in the early post-operative period, 7 (12%) patients suffered from knee stiffness, and there were 3 (12%) cases with a pre-operative bone loss that required bone grafting.Conclusion:Management of complex intra-articular distal femur fracture has always been a challenge. Anatomical reduction of articular fragments and rigid fixation of these fractures are a must. DFLP provides angular stability with multiple options to secure fixation of both metaphyseal and articular fragments with the restoration of the joint congruity, limb length, alignment and rotation, allowing early mobilisation and aggressive physiotherapy without loss of fixation, resulting in gratifying functional outcome and low complication rate.

Maintaining the Neutral Axis in the Treatment of Distal Femur Fractures Via Dual Plate or Nail Plate Combination Technique: When and How?

Distal femur fractures in the elderly have been historically treated with locked plating or retrograde intramedullary nailing with good, reliable results. However, in certain more complex fracture patterns (native or periprosthetic), increased density of fixation via dual-plate or nail plate combination can help achieve immediate weight-bearing. It can also potentially increase rates of union by shifting and maintaining the neutral axis, distributing forces more evenly across the fracture site. Here, we discuss the indications, pros and cons of both dual-plate and nail plate combination techniques in a concise case-based format.

Assessing the functional outcome after fixation of distal femoral fractures with DF-LCP: A prospective study.

Background: Management of distal femoral fractures remains a real challenge due to the involvement of unique and vital anatomical structures. These are usually treated with operative measures. Distal femoral locking compression plate (DF-LCP) has gained popularity due to favorable biological insertion and minimal periosteal damage, but locally little is known about it. Therefore, the present study aimed to identify the functional outcomes after fixation of distal femoral fractures with DF-LCP.&#x0D; Methodology: This prospective cohort study, including 21 patients with distal femoral fractures, was conducted at Abbasi Shaheed Hospital from Jan 1, 2017, to Dec 31, 2018. All enrolled patients were treated with DF-LCP. The postoperative clinical and radiological outcomes were evaluated for one year. The data were statistically analyzed using SPSS version 22.0.&#x0D; Results: There were 21 patients with distal femur fractures with a mean age of 46.6 ± 19.2 years. The majority of the fractures were due to road traffic accidents (RTA), i.e., 57.1%, followed by ground-level fall (33.3%). The mean time for fracture union was 20.2 ± 11.1 weeks, and the mean range of motion of the knee was 108.5 ± 18.5º (at one-year follow-up). The complications were minimal; superficial infection and stiffness of knee joint were observed in 2 patients each while there was 1 case each of non-union, delayed union, and implant failure.&#x0D; Conclusion: DF-LCP is an effective treatment for distal femoral fractures as it permits stable fixation and early mobilization. Satisfactory to excellent functional and radiological outcomes were achieved.&#x0D;

Outcome of Distal Femoral Fracture Treated with Locking Plate

Objective: The aim of this study is to determine the outcome of distal femoral fracture treated with locking plate. Study Design:Prospective study Place and Duration: Conducted at Orthopaedic Unit Ayub Medical Teaching Institute, Abbottabad for one year duration from 1stJanuary 2020 to 31st December 2020. Methods: Total 90 patients of both genders were presented in this study.Patients were aged between 18-80 years of age. Patients’ detailed demographics including age, sex and body mass index were recorded after taking informed written consent. All the patients had distal femoral fracture treated with locking plate. Radiological assessment was done. Mean union time and complications associated to procedure were examined.Functional outcomes were analyzed according to the Flyn’s criteria. Follow-up was taken at 6 months postoperatively. Complete data was analyzed by SPSS 24.0 version. Results:There were 58 (64.4%) patients were males and 32 (35.6%) were females. Mean age of the patients were 42.61±12.88 years with mean BMI 27.65±9.56 kg/m2. According AO/OTA classification 55 (61.1%) had A1, A2 fracture was among 18 (20%) cases and the rest were 17 (18.9%) had A3. 62 (68.9%) fractures were caused due road traffic accidents, falling from height were among 17 (18.9%) cases and 11 (12.2%) cases were due to sports. Right side fracture was the most common side of fracture among 54 (60%). Mean union time among patients was 5.16±1.27 months.According to Flyn’s criteria, 38 (42.2%) cases had excellent results, 32 (35.6%) patients had good, fair results were among 16 (17.8%) cases and poor results were among 4 (4.4%) cases. Complications were delayed union, stiffness, varus deformityand non union observed among all cases. Conclusion: We concluded in this study that the locking plate for the treatment of distal femoral fractures was effective in terms of good results with fewer complications. Keywords:Distal femoral fracture, Locking plate, RTA, Complications

FUNCTIONAL OUTCOME OF DISTAL FEMORAL FRACTURES AND THEIR MANAGEMENT

Background: Fractures of distal end of femur are complex injuries which are difficult to manage. These fractures often are unstable and comminuted. Despite advances in surgical techniques and improvement in implants, treatment of distal femoral fractures remains a challenge in many situations. This study was done to analyse the functional outcome and this management of distal femoral fractures. Material &amp; Methods: This study has been done between August 2008 to March 2010 on patients coming to Orthopaedics Department at Jawaharlal Nehru Hospital and Research Center, Bhilai. It is a prospective study which includes 25 patients with 10 Type A, 7 Type B and 8 Type C fractures of distal femur after fulfilling the inclusion and exclusion criteria. Results: Mean age of 47.08 years with sex incidence of 3.17:1(M:F). Mode of injury was RTA in 16, simple fall in 6, fall from height in 2 and railway track accident in 1 patient. There were 5-A1, 1-A2, 4-A3, 3-B1, 1-B2, 3-B3, 1-C1, 4-C2 and 3-C3 fractures. Results were found to be excellent in 17, good in 1, moderate in 3 and poor in 4 patients. Conclusion: We conclude that minimally invasive surgical techniques and with the availability of locking type of plates distal femoral fractures can now be dealt with more precessions and more satisfactory results can be produced. Keywords: Distal fractures, Muller Classification, Management, Femoral fractures

Clinical application of lower extremity axial distractor in closed reduction and retrograde intramedullary nail fixation of distal femoral fractures

To explore the efficacy and advantages of the lower extremity axial distractor assisted closed reduction and retrograde intramedullary nail internal fixation in the treatment of distal femoral fractures. The clinical data of 49 patients with distal femoral fractures treated with retrograde intramedullary nail internal fixation between April 2016 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative reduction, the patients were divided into trial group (29 cases, using lower extremity axial distractor to assist closed reduction) and control group (20 cases, using free-hand retraction reduction). There was no significant difference in general information between the two groups ( P>0.05), such as gender, age, side of injury, cause of injury, and fracture classification. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, and callus formation time were recorded and compared between the two groups. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation. All patients successfully completed the operation. In the control group, there was 1 case with open reduction and internal fixation, and the rest of the two groups were closed reduction. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups ( P>0.05). There was no complication such as vascular or nerve injury and iatrogenic fracture, etc. during and after operation, and the incisions healed by first intention. Except for 2 patients in the trial group who were lost to follow-up at 3 months after operation, the rest of the patients were followed up 12-36 months, with an average of 16.0 months. There was no significant difference in the callus formation time between the two groups ( t=2.195, P=0.145). During the follow-up, postoperative knee joint stiffness occurred in 1 case in the control group, which improved by strengthening the knee joint function exercise and removing the internal fixator; the rest were not found to be associated with delayed or nonunion fractures, knee stiffness, and internal fixation complication. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation, the trial group achieved excellent results in 22 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 96.3%; in the control group, the results were excellent in 16 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate was 95.0%; showing no significant difference in the excellent and good rate between the two groups ( χ 2=0.451, P=0.502). The lower extremity axial distractor assisted closed reduction and retrograde intramedullary nailing for the treatment of distal femoral fractures is convenient, which has satisfactory efficacy.

To Study Surgical Management of Distal Femoral Fractures &amp; its Complication

Background: Fractures of distal end of femur are complex injuries which are difficult to manage. These fractures often are unstable and comminuted. Despite advances in surgical techniques and improvement in implants, treatment of distal femoral fractures remains a challenge in many situations. This study was done to analyse the functional outcome and this management of distal femoral fractures with its complication. Material &amp; Methods: This study has been done between August 2008 to March 2010 on patients coming to Orthopaedics Department at Jawaharlal Nehru Hospital and Research Centre, Bhilai. It is a prospective study which includes 25 patients with 10 Type A, 7 Type B and 8 Type C fractures of distal femur after fulfilling the inclusion and exclusion criteria. Results: Mean age of 47.08 years with sex incidence of 3.17:1(M:F). Mode of injury was RTA in 16, simple fall in 6, fall from height in 2 and railway track accident in 1 patient. There were 5-A1, 1-A2, 4-A3, 3-B1, 1-B2, 3-B3, 1-C1, 4-C2 and 3-C3 fractures. Complication in form of varus angulation was found in 5 cases, shortening occurred in 2 patients, backing out of distal femoral locking screw occurred in 1 patient. Deep infection occurred in 1 patient. Implant failure and varus angulation at fracture site occurred in 1 patient. Conclusion: We conclude that minimally invasive surgical techniques and with the availability of locking type of plates distal femoral fractures can now be dealt with more precessions and more satisfactory results can be produced. Keywords: Complication, Muller Classification, Management, Femoral fractures.

Biomechanical and anatomical considerations for dual plating of distal femur fractures: a systematic literature review.

Distal femur fractures are challenging injuries historically associated with high rates of nonunion and varus collapse with operative management. As a result, clinical and research interest in dual plating (DP) of distal femur fractures has seen a dramatic increase in recent years. The purpose of this study was to systematically review the literature regarding vascular anatomy and biomechanics of distal femur fractures treated with DP constructs. A systematic literature review of two medical databases (PubMed & Scopus) was performed to identify peer-reviewed studies on the anatomy and biomechanics regarding DP of distal femur fractures. A total of 1,001 papers were evaluated and 14 papers met inclusion criteria (6 anatomy and 8 biomechanics). Methodological quality scores were used to assess quality and potential bias in the included studies. In the biomechanical studies, DP constructs demonstrated greater axial and rotational stiffness, as well as less displacement and fewer incidences of failure compared to all other constructs. Vascular studies showed that the femoral artery crosses the mid-shaft femur approximately 16.0-18.8cm proximal to the adductor tubercle and it is located on average 16.6-31.1mm from the femoral shaft at this location, suggesting that medial plate application can be achieved safely in the distal femur. The methodological quality of the included studies was good for biomechanical studies (Traa score 79.1; range 53-92.5) and excellent for anatomical studies (QUACs score 81.9; range 69.0-88.5). Existing biomechanics literature suggests that DP constructs are mechanically stronger than other constructscommonly used in the treatment of distal femur fractures. Furthermore, medial distal femoral anatomy allows for safe application of DP constructs, even in a minimally invasive fashion. Dual plating should be considered for patients withdistal femur fracturesthat have risk factors for instability, varus collapse, or nonunion.

Regional anesthesia does not decrease inpatient or outpatient opioid demand in distal femur fracture surgery.

Regional anesthesia (RA) is sometimes used to decrease pain and opioid consumption in distal femur fractures. However, the real-world impact of RA on inpatient opioid consumption and outpatient opioid demand is not well known. The hypothesis of this study is that RA would be associated with decreased inpatient opioid consumption and outpatient opioid demand. This study evaluated inpatient post-operative opioid consumption (0-24h, 24-48h, 48-72h) and outpatient opioid demand (discharge to 2weeks, 6weeks, and 90days) in all patients ages 18 and older undergoing operative treatment of distal femur fractures at a single institution from 7/2013 to 7/2018 (n = 230). Unadjusted and adjusted multivariable models were used to evaluate the impact of RA and other baseline patient and operative characteristics on inpatient opioid consumption and outpatient opioid demand. Adjusted models demonstrated a small, significant increase in inpatient opioid consumption in patients with RA compared to no RA (4.7 estimated OE's without RA vs 6.2 OE's with RA from 24- to 48-h post-op, p < 0.05) but otherwise no significant differences at other timepoints (6.7 estimated OE's without RA vs 6.9 OE's with RA from 0- to 24-h post-op and 4.5 vs 4.4 from 48- to 72-h post-op, p > 0.05). Estimated cumulative outpatient opioid demand was significantly higher in patients with RA from discharge to 6weeks and to 90days (55.8 OE's without RA vs 63.9 with RA from discharge to 2weeks, p > 0.05; 74.9 vs 95.1 OE's to 6weeks, and 85 vs 113.1 OE's to 90days, p < 0.05). In distal femur fracture surgery, RA was associated with increased inpatient and outpatient opioid demand after adjusting for baseline patient and treatment characteristics. These results call into question the routine use of RA in distal femur fractures. Level III, retrospective, therapeutic cohort study.

Application of a double reverse traction repositor in the retrograde intramedullary nailing of distal femur fractures

ObjectiveThe purpose of this prospective study was to introduce the application of a double reverse traction repositor (DRTR) in the retrograde intramedullary nailing (RE-IMN) of AO/OTA 33A distal femur fractures.Patients and methodsA total of 27 patients with AO/OTA type 33A distal femur fractures who were admitted from January 2015 to May 2017 to a level I trauma center of a tertiary university hospital were enrolled in this prospective study. A DRTR was used to facilitate RE-IMN for the reduction of distal femur fractures in all patients. The demographic and fracture characteristics, surgical data, postoperative complications, and prognostic indicators of 24 patients were recorded.ResultsThe DRTR helped achieve and maintain the reduction of all distal femur fractures in the present study. All surgeries were conducted by closed reduction, and excellent alignment was observed in the postoperative X-ray images. In the present study, 18 males and 6 females were included, and the average age of all patients was 51.3 years (range, 24–68 years). The mean operation time, intraoperative blood loss, intraoperative fluoroscopy time, and length of postoperative hospital stay were 137 min (range from 80 to 210 min), 320 ml (range from 200 to 600 ml), 28 (from 24 to 33), and 9 days (from 5 to 14 days), respectively. Eleven patients were found to have postoperative deep venous thrombosis before discharge. No cases of wound infection were observed. No cases of nonunion or malunion were observed. The average follow-up duration was 21 months (18–30 months). The average HHS, LKFS, and VAS scores at the 1-year follow-up were 89.9 (86–97), 79.1 (75–87), and 2.1 (from 0 to 5). No complications associated with DRTR were found.ConclusionsA DRTR can be successfully applied in the treatment of distal femur fractures with RE-IMN, and it can not only help achieve or maintain the reduction of distal femur fractures with closed methods but also promote fixation with RE-IMN.

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.&#x0D; 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.&#x0D; 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.&#x0D; 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 =&lt;0.0001). Further the flexion was significantly higher in 24 weeks as that of the 6 and 12 weeks (P =&lt;0.0001).&#x0D; 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.