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Objective: To explore the early effectiveness and advantages of mini-Swashbuckler approach in treatment of distal femoral type C fractures by comparing with Swashbuckler approach. Methods: A retrospective analysis was made on 43 patients with distal femoral type C fractures between January 2014 and June 2018. Twenty-two patients were treated with open reduction via mini-Swashbuckler approach and internal fixation with less invasive stabilization system (LISS) plate in modified group; and 21 patients were treated with open reduction via Swashbuckler approach and internal fixation with LISS plate in traditional group. There was no significant difference in age, gender, cause of trauma, fracture classification, fracture side, interval between injury and operation, and complications between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy times, hospitalization time, fracture healing time, Hospital for Special Surgery (HSS) scores of the knee, and postoperative complications were recorded and compared between the two groups. Results: The operation successfully completed in both groups. The operation time of the modified group was significantly longer than that of the traditional group, the fluoroscopy times was increased and the blood loss was reduced, the differences were significant ( P0.05). Conclusion: Compared with Swashbuckler approach, mini-Swashbuckler approach has limited visual field exposure, which leads to prolonged operation time and increased fluoroscopy times, but the risks of complications do not increase. Because of its small soft tissue injury and less blood loss, it is conducive to the recovery of knee joint function after operation.
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Objective: To analyze the effectiveness of flexible internal fixation with locking plate for distal femoral fractures.
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Objective: To investigate current status and latest progress of clinical research on distal femoral fractures.
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Objective To evaluate the efficacy of less invasive stabilization systems (LISS) fixation and double plating on the treatment of AO-type C3 distal femoral fractures via anterior midline approach.Methods From June 2014 to March 2017,18 cases of AO-type C3 distal femoral fractures treated in our department were recruited in this study.They were 12 males and 6 females,at a mean age of 19-62 years.There were 11 cases due to traffic accidents and 7 due to falls from heights.Six of them had open fractures and 12 had closed fractures.They all were treated with LISS fixation and double plating with anterior midline incision.Kolment and Wulff criteria were used to evaluate knee joint function after internal fixation at the last time of follow-up.Results For all the subjects,the average operative time was 145 (110 to 200) min,and they were followed up for 17.5 (12 to 25) months.They all achieved primary wound healing,and had an average time of 22 (20 to 26) weeks for fracture healing.No nonunion,infection,osteomyelitis or injuries of nerves and arteries were observed.According to the results of Kolment and Wulff criteria for knee joint function evaluation,6 of them got excellent,9 good,2 fair and 1 poor outcomes,with a rate of 83.33％ for good and excellent outcomes.Conclusion The treatment of type C3 distal femoral fractures via anterior middle approach of knee joint can fully reveal the articular surface of the femoral condyle.And the operative vision is clear,making it easy for anatomical reduction of articular surface fractures.Combined with LISS double locking plates fixation treatment,it can avoid the injury of soft tissue,and the fracture also be rigid fixation.Postoperative early functional exercise should be allowed to obtain good clinical results.
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Objective To compare the biomechanical stability of distal femoral fracture with metaphyseal comminution fixed by unilateral or bilateral locking plates. Methods Distal femoral fracture with metaphyseal comminution (AO type C2.3 fracture) models were established in 22 artificial femoral specimens, and randomly divided into single plate group (group A, n=11) and double-plate group (group B, n=11). In group A, the fractures were fixed by lateral anatomic locking plates, and in group B, the fractures were fixed by lateral anatomical locking plates at lateral side and straight locking plates medially, respectively. In each group, 5 specimens were applied with axial compression and 3 specimens were applied with cyclic axial loading to measure medial subsidence, and the remaining 3 specimens were applied with failure loading to record the maximum load to failure. Results For axial compression, the mean medial subsidence of group A and group B were (2.61±0.28) mm and (0.46±0.08) mm, respectively. For cyclic axial loading, the mean medial subsidence of group A and group B were (1.56±0.12) mm and (0.43±0.05) mm, respectively. For failure loading, the maximum loads to failure of group A and group B were (5 567±338) N and (9 147±186) N, respectively, which all showed significant differences in two groups (P＜0.05). Conclusions For fixing distal femoral fracture with metaphyseal comminution, bilateral locking plates show stronger resistance to medial compression than unilateral locking plates and thus increase the stability of medial column of distal femur, which contributes to patient rehabilitation at early stage.
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PURPOSE: Primary total knee arthroplasty (TKA) can be an alternative method for treating distal femoral fractures in elderly patients with knee osteoarthritis. The purpose of this study was to evaluate the clinical and radiographic results in patients with knee osteoarthritis who underwent TKA with the Medial Pivot prosthesis for distal femoral fractures. MATERIALS AND METHODS: Eight displaced distal femoral fractures in 8 patients were treated with TKA using the Medial Pivot prosthesis and internal fixation. The radiographic and clinical evaluations were performed using simple radiographs and Hospital for Special Surgery (HSS) knee scores during a mean follow-up period of 49 months. RESULTS: All fractures united and the mean time to radiographic union was 15 weeks. The mean range of motion of the knee joint was 114.3degrees and the mean HSS knee score was 85.1 at the final follow-up. CONCLUSIONS: Based on the radiographic and clinical results, TKA with internal fixation can be considered as an option for the treatment of simple distal femoral fractures in elderly patients who have advanced osteoarthritis of the knee with appropriate bone stock.
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Aged , Humans , Arthroplasty , Femoral Fractures , Follow-Up Studies , Knee , Knee Joint , Osteoarthritis , Osteoarthritis, Knee , Prostheses and Implants , Range of Motion, ArticularABSTRACT
PURPOSE: To evaluate the efficacy of surgical treatment through retrospective comparison of minimally invasive percutaneous plate osteosynthesis (MIPPO) vs open plate fixation in the treatment of the distal femur fractures. MATERIALS AND METHODS: Thirty-one patients with distal femur fractures from January 2002 to December 2010 were divided into two groups depending on the surgical method. Minimum follow up was 12 months. Group A consisted of 17 patients treated with MIPPO, and group B was comprised of 14 patients treated with open plate fixation. Clinical outcomes including operation time, transfusion rate, rehabilitation, range of motion, and interval change of postoperative C-reactive protein (CRP) were evaluated to assess postoperative inflammatory reaction, postoperative complications and clinical results with the use of Sanders criteria. RESULTS: The operative time was 86/135 min and transfusion volume was 0.8/1.9 unit respectively. The postoperative 3-day and 7-day CRP were 7.4/1.5 mg% in group A and 10.3/2.4 mg% in group B, showing more minimal tissue injury and early recovery in group A. There were no significant differences in clinical results by Sanders criteria in both groups. CONCLUSION: Both MIPPO and open plate fixation for the treatment of distal femur fractures showed comparably good results. However, the MIPPO technique is superior to group B in view of minimal tissue injury and operation time and was proven to lessen the transfusion rate.
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Humans , C-Reactive Protein , Femur , Follow-Up Studies , Operative Time , Postoperative Complications , Range of Motion, Articular , Retrospective StudiesABSTRACT
PURPOSE: To compare results of minimally invasive plate osteosynthesis using a locking compression plate and a periarticular locking plate in distal femur fractures. MATERIALS AND METHODS: We retrospectively reviewed 31 consecutive femoral fractures who treated by minimally invasive plate osteosynthesis from April 2006 to May 2009. Sixteen patients were treated using a locking compression plate (group A) and 15 patients were treated using a periarticular locking plate (group B). RESULTS: The mean operation time was 78 minutes and 76 minutes (p=0.273), and the mean radiation exposure time was 1.9 minutes and 2.3 minutes (p=0.001) in the group A and B, respectively. The plate bending during operation was performed in 4 cases of group A. The knee range of motion was 117.5degrees and 118.2degrees (p=0.825), and the Lysholm score was 81.3 and 81.8 (p=0.723) in the group A and B, respectively. Schazker criteria showed more than good grade in 93.8% of group A and in 93.3% of group B (p=1.0). CONCLUSION: No significant differences in clinical results were observed between the two groups. However, a lower anatomical compliance was showed in the locking compression plate, and a higher risk of radiation exposure was showed in the periarticular locking plate.
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Humans , Compliance , Femoral Fractures , Femur , Knee , Range of Motion, Articular , Retrospective StudiesABSTRACT
PURPOSE: To report the clinical outcome of polyaxial locking plate (Noncontact bridging (NCB) plate (Zimmer, Warsaw, Indiana)) for the treatment of distal femur fracture with minimal invasive percutaneous periosteal osteosynthsis (MIPPO) technique. MATERIALS AND METHODS: Between February 2008 to April 2010, twenty six patients (11 men, 15 women), twenty eight cases diagnosed as distal femoral fractures are enrolled in this retrospective study. The mean age of the patients was 63 years (34 to 85) and the mean follow-up was 20.3 months (12 to 32). According to the AO/ASIF classification, 15 fractures were type A, 1 type B and 9 type C. And there were 3 periprsthetic fractures around knee. The analysis of the clinical and radiologic outcome were performed by Sanders functional evaluation scale and radiologic follow up after operation, respectively. RESULTS: Among 28 cases, 25 cases united without additional operation. According to Sanders functional evaluation scale, there were 11 excellent, 9 good, 4 fair, 2 poor. As complications, there were 1 knee stiffness, 1 delayed union, 1 implant failure with refracture, 1 implant loosening. Three patients except one knee stiffness, underwent a second LISS plating using NCB plate and and bone grafting, resulting in a satisfactory final outcome. CONCLUSION: Internal fixation using polyaxial locking plate with MIPO technique may be one of the most effective methods for the treatment of distal femoral fractures.
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Humans , Male , Bone Transplantation , Femoral Fractures , Femur , Follow-Up Studies , Knee , Retrospective StudiesABSTRACT
Objective To summarize the therapeutic effect of minimally invasive percutaneous plate esteosynthesis (M1PPO) with less invasive stabilization system (LISS) in distal femoral fractures. Method Twenty-eight patients with LISS in distal femoral fractures between June 2004 and May 2005 were analyzed retrospectively. Results The average following up period was ( 17.6 ± 0.1 )months (6-30 months) all 28 cases,only one case of delayed union,the others were no complications. According to Johner-Wruh score standard,28 cases were excellent 16,good 9,fair 2 and poor 1,the rate of excellent and good was 89.3%. Conclusion The therapeutic effect of MIPPO with LISS in distal femoral fractures is satisfactory.
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We conducted a retrospective review on eleven patients who were treated for Type A and C distal femoral fractures (based on AO classification) between January 2004 and December 2004. All fractures were fixed with titanium distal femoral locking compression plate. The patients ages ranged from 15 to 85 with a mean of 44. Clinical assessment was conducted at least 6 months post operatively using the Schatzker scoring system. Results showed that four patients had excellent results, four good, two fair and on
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PURPOSE: To evaluate the clinical and radiologic results of minimally invasive plate osteosynthesis, We analyzed the cases of distal femoral fracture treated with this newly developed surgical technique. MATERIALS AND METHODS: We reviewed 12 cases of distal femoral fracture which had been treated with minimally invasive plate osteosynthesis and each patients had been followed up for a minimum twelve months. Post-operative function was evaluated with checking the range of motion of knee joint and Knee Society Score. Union period and post-operative alignment was measured on radiograph. RESULTS: In all cases, bony union was obtained in average fifteen weeks after operation without bone graft. The arc of motion of knee joint which was checked at the last follow up was 123.75 degrees on average. According to Knee Society Score, there were 9 excellent, 1 fair and 1 poor results. The post-operative complications were malunion in 1 case, soft tissue infection in 1 case and joint stiffness in 1 case. CONCLUSION: The treatment of distal femoral fracture with minimally invasive plate osteosynthesis is one of the good surgical options for clinically preferable results with high union rate without bone graft and early joint motion.
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Humans , Femoral Fractures , Follow-Up Studies , Joints , Knee , Knee Joint , Range of Motion, Articular , Soft Tissue Infections , TransplantsABSTRACT
PURPOSE: To evaluate the result of comparative study about the cases in the fracture of the distal femur treated with plate and screw, dynamic condylar screw, blade plate, retrograde intramedullary nail and external fixator. MATERIALS AND METHODS: The AO classification system was used. 84 cases who were preformed operation during the period from March 1996 to May 2002, were included in this study. The mean duration of follow-up was 25 months. According to Sachatzker criteria, we classified the following results to excellent, good, fair and poor. RESULTS: Type A were excellent or good result when treated with plate and screw, dynamic condylar screw and retrograde intramedullary nail. Type B were excellent or good result when treated with cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate. CONCLUSION: We conclude that the most important thing in operation is firmly internal fixation and to obtain this, accurately anatomical reduction and the choice of suitable instrument for the type of the fracture are needed. cannulated screw. Type C were excellent or good result when treated with plate and screw and blade plate.
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Classification , External Fixators , Femoral Fractures , Femur , Follow-Up StudiesABSTRACT
PURPOSE: To evaluate the usefulness of early range of motion exercise by using 90degrees knee flexion splint after open reduction and internal fixation in fracture of distal femur. MATERIALS AND METHODS: We reviewed twenty-six cases of distal femur fractures which were treated with open reduction and internal fixation from February 2002 to November 2003. One group (group A) were treated by using 30degrees knee flexion splint, the other group (group B) were treated by using 90degrees flexion and full extension splint alternativley by post-operative 1 week. The follow up period was minimally 12 months. The range of motion and Schatzker and Lambert criteria were evaluated. RESULTS: The mean period to gain 90degrees knee flexion was 11.4 (7~14) weeks in group A, and 6.6 (3~8) weeks in group B. Mean range of motion was 94.7degrees (average flexion contracture 9.5degrees ) in A group and 108.7degrees (average flexion contracture 6.3degrees ) in B group at 12 weeks follow-up. According to Schatzker and Lambert criteria, excellent result was achieved in 10 cases (38%), good result in 13 cases (50%), fair result in 3 cases (12%). CONCLUSION: This study demonstrates that alternative splinting at extension and 90degrees flexion contribute to early recovery of range of motion in distal femur fractures treated with internal fixation.
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Contracture , Femur , Follow-Up Studies , Knee , Range of Motion, Articular , SplintsABSTRACT
Objective To retrospectively report 30 cases of distal femoral fractures treated with retrograde intramedullary interlocking naill( GSH nail). Methods From February 1999 to December 2002, 30 cases of distal femoral fractures were treated with GSH nails.According to AO/ASIF classification system, there were 11 cases of type A1, 7 A2, 3 A3, 5 C1, 3 C2 ,and 1 C3 .The follow up period ranged from 6 to 54 months. Results The average time for bone healing was 16 weeks. According to Neer s knee rating scale, there were 21 excellent cases and 5 good; the excellent and good rate was 86.6% . Conclusion It's a good method to treat type A& C (AO/ASIF) distal femoral fractures with GSH nail.
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Objective To report the clinical application of Dynamic Condylar Screw(DCS) in treatment of 15 cases of distal femoral fractures. Methods All cases of the distal femoral fractures were treated with DCS, and given different fixation according to different types of the fracture,and CPM was used after operation. Results All patients were followed up for a period from 6 months to 12 months.The excellent and good rate of functional recovery was 86.7%. Conclusions DCS is a good method to treat distal femoral fractures.
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Since Green et al has introduced a new technique of retrograde intramedullary nail, the use of retrograde interlocking intramedullary nails has been recommended as one of the treatment options for the distal femoral fracture. However there are some disadvantages that an arthrotomy is required for insertion and the knee joint could often be violated. Authors present a simple, arthroscopically assisted method using the retrograde intramedullary nailing for distal femoral fractures with minimal invasiveness to the knee. From March 1995 to March 1997, the retrograde intramedullary nail was used to treat 9 distal femoral fractures. Five of 9 patients were fractured at the distal shaft of the femur and others were fractured at the supracondylar region of the femur. Only one of the fractures was open injury(Gustilo-Anderson grade II). Significant concomitant knee joint injuries were revealed through the arthroscopy in 3 patients. Eight of 9 fractures healed by 5 months, but one fracture was not healed and required bone grafting. Average knee range of motion was 130. Complications included 1 nonunion and 1 hardware failure. There were no patellofemoral problems and no posttraumatic arthritis of the knee joint. This arthroscope-assisted method have some potential benefits that include decreased risk of damage to the knee joint, early evaluation and treatment of the associated knee joint injuries, and accurate placement of the nail.
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Humans , Arthritis , Arthroscopy , Bone Transplantation , Femoral Fractures , Femur , Fracture Fixation, Intramedullary , Knee , Knee Joint , Range of Motion, ArticularABSTRACT
Objective To analyze the characteristics of military training injury caused by distal femoral fractures that used reverse interlocking intramedullary nail(retrograte nails) and condylar plate to fix,and then compare the clinical treatment effects.Methods Retrospective analysis of clinical information of 30 cases,14 cases were treated with reverse interlocking intramedullary nail(reverse nail group) and 16 cases with condyle plate fixation(condyle plate group),all the cases were followed up for 12～20 months to compare the treatment effect and complications.Results According to Merchan criteria with clinical evaluation of knee function,the rate of good and excellent was 85.7% in the reverse interlocking in-tramedullary nail group,68.7%(P
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Fractures involving joints and about the joints provide complex problems with small comminuted fractures, surrounding soft tissue injuries and articular cartilage damage. Various problems are also encountered on the weight bearing surface, especially on the convex side of the distal Femur. Even though many auther had recommended kinds of management upto now, operative methods are more suggested in order to get good results regarding with the accurate anatomical reduction, rigid internal fixation and early joint motion. The clinical analysis of rnanagements of 20 cases of distai femoral fracture demonstrate that seperate dual incision-bilateral or right angle plane-to originate fracture site, and anatomical reduction & rigid internal fixation, early non-weight bearing ROM exercise of joint were sometimes mandatory to treat the displaced, comminuted fracture.