Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen / 中华创伤杂志(英文版)

Purpose:@#Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%-10% of the all distal femoral fractures, which is at an increased risk of complications. There were limited studies which documented the outcomes of such cases. The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.@*Methods:@#This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India. Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. They were followed for minimum of six months. Patients were followed up monthly for first four months, at six months and one year after surgery. Clinical and radiological signs of healing, any complications, time to union, and functional outcome were assessed.@*Results:@#The mean age of patients was 44.33 years (range 20-82 years) with male predominance of 66.7%. According to Gustilo-Anderson classification, there were 5, 15 and 10 patients with open grade I, II and IIIA distal femoral fractures respectively. According to orthopaedic trauma association (OTA) classification, majority of patients in our study were of C3 type. The mean time to bony union was 5.6 months (range 4-9 months). Average postoperative knee range of motion (ROM) at the latest follow-up was 98° (range 70°-120°). Lysholm knee scoring scale showed excellent score in 11 patients, good in 9 patients, fair and poor in 5 patients each; however, there was no significant correlation with fracture pattern types (p < 0.05). Knee stiffness was the major complications encountered in the study. The knee ROM was <90° in 5 patients and 90°-120° in rest of the patients, while 1 patient had extensor lag of 10°. One patient had implant failure and lost to follow-up; 3 patients had deep infection.@*Conclusion:@#An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.

Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion

PURPOSE: Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (age≥60) and to determine the risk factors related witht he occurrence of nonunion. MATERIALS AND METHODS: This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion. RESULTS: The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045). CONCLUSION: The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.

Distal Femur Fractures and its Treatment with Distal Femur Locking Plate.

In this prospective study, 50 patients with distal femur fracture were treated using distal femur locking plate. Extra-articular fractures were fixed with minimal invasive technique without exposing the fracture site and intra-articular fractures were treated by open technique. Schatzker and Lambert (1979) criteria is used for functional assessment. In our series majority of the patients were males (70%), predominantly with AO type C fracture. RTA was the major mode of trauma (80%). Average union time was 14.2 weeks and average range of motion was 109.50. According to Schatzker and Lambert's criteria 22 patients had excellent results, 16 patients had good results, 8 patients had fair results and 4 patients had failure. We conclude that this implant should be used in distal femur fractures especially in, fractures with articular extension and comminution. Locking compression plate allows early weight bearing which is an additional advantage for good vocational, mental, social and physical health.

The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur

PURPOSE: This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma. MATERIALS AND METHODS: Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated. RESULTS: The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores. CONCLUSION: The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

Condylar buttress plate for fixation of distal femur fracture: Functional and anatomical evaluation.

Background: Distal Femur fractures are one of the common fractures occurring in road traffic accidents. Various modalities are used for fracture of distal femur, one of them is condylar buttress plate. Various studies have claimed better results in surgical management of distal femur fracture. This study was planned to compare two treatment modalities for supracondylar and intercondylar fracture of the femur, open reduction and internal fixation with a condylar buttress plate. Aims & Objective: Objective of this study was to study the surgical technique for fixation of lower end femur fractures with condylar buttress plate and its functional and anatomical outcome. Materials and Methods: Total 30 patients above 18 years of age irrespective of gender, having fresh displaced and undisplaced fractures type A1, A2, A3, C1, C2,C3 and nonunion of distal femur fractures. Distal femur fracture was fixed with condylar buttress plate Results: A total of 30 cases were studied comprising 21 males (70%) and 9 females (30%) of which mean age is 37 years. Mean hospital stay was 35.8 days, out of 30 patient 11 patients developed some complication. 22 patients have good to excellent results as outcome. Conclusion: The Condylar Buttress Plate is an effective method for the treatment of Supracondylar and intercondylar fractures of the femur.

Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture

PURPOSE: To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness. MATERIALS AND METHODS: From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications. RESULTS: In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases. CONCLUSION: The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.

Treatment of Distal Femur Fracture with Minimally Invasive Locking Compression Plate Osteosynthesis

PURPOSE: To analyze the result of distal femur fracture treatment with minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP). MATERIALS AND METHODS: From December 2004 to April 2010, 33 patients with distal femur fractures were treated by MIPO with a locking compression plate. The reduction state and bone union time was checked radiologically. The clinical outcome was evaluated by the Schatzker and Lambert criteria. RESULTS: The mean bone union time was 16.3 weeks (10~22 weeks). There were 3 nonunions, 2 broken plates, 1 superficial infection, 7degrees of valgus angulation in 1 case, and 1.5 cm limb shortening in 1 case. Except for the 3 nonunion cases, according to the Schatzker and Lambert criteria, results were graded as excellent in 11 cases, good in 14 cases, and moderate in 5 cases. CONCLUSION: The treatment of distal femoral fracture by MIPO with a locking compression plate resulted in good functional and radiological outcomes, but it has problems, such as broken plates and nonunion. Accurate surgical technique and appropriate treatment will be needed according to fracture type.

Retrograde Intramedullary Nailing for Distal Femur Fracture with Osteoporosis

BACKGROUND: The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. METHODS: Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and managed with retrograde intramedullary nailing were retrospectively reviewed. Cement augmentation was used in four patients, shape memory alloy was used in eight patients and both were used in one patient. All patients were followed up for more than 2 years. Radiologic alignments. were scored and Tegner and the Lysholm activity score was used for a functional assessment. RESULTS: The average time to clinical union was 13 weeks (range, 10 to 15 weeks). In 12 of our cases, the total alignment scores were excellent. At the last follow-up, the mean range of motion was 116degrees (range, 110degrees to 125degrees). The average functional score at postoperative 1 year was 2.6 (range, 1 to 5). CONCLUSIONS: Retrograde intramedullary nailing is a good surgical option for distal femur fracture with osteoporosis. Cement augmentation and shape memory alloy can also be used for added mechanical stability. This surgical technique is very useful for distal femur fracture with osteoporosis as it promotes fracture healing and early rehabilitation.

The Effectiveness of Locking Compression Plate Fixation for Distal Femur Fracture in Elderly Patients with Osteoporosis / 대한골다공증학회지

OBJECTIVES: To analyze the surgical results of distal femur fracture in patients over 65 years old with osteoporosis using locking compression plate.

Treatment of the Distal Femur Fracture with Retrograde Intramedullary Nailing

PURPOSE: To evaluate the results and complications of the retrograde intramedullary nailing for the treatment of distal femur fracture. MATERIALS AND METHODS: Thirty three patients who received retrograde IM nailing for fractures of the distal femur between October 1998 to December 2003. Average age was 53.8+/-17 (17~86) years. The average follow up period was 19.4 (12~36) months. Clinical information included age, sex distribution, associated fracture and fracture was classified by AO classification. Functional result was evaluated by Schatzker's criteria. RESULTS: The most common cause of injury was traffic accident (60%). The type of fracture were 6 A1 cases, 5 A2 cases, 11 A3 cases, 5 C2 cases, 6 C3 cases by AO classification. Among the 33 cases, 15 cases were excellent, 9 good, 6 fair and 1 failure according to Schatzker's criteria. Average union time was 9.7+/-3.5 months. CONCLUSION: Treatment of distal femur fracture with retrograde intramedullary nailing was useful due to its minimal invasiveness and early range of motion, more rigid fixation.

Treatment of Distal Femoral Shaft and Supracondylar Fracture with aRetrograde Intramedullary Nailing

PURPOSE: Retrograde intramedullary nailing has been recommended as one of the treatment options for the distal femoral fracture, particularly in patients who are obese, are pregnant, has sustained ipsilateral femoral neck fracture, have multiple injuries. However there are some disadvantage such as post-arthrotomy infection, knee joint stiffness. This paper is to evaluate the result and complication of treatment of distal femoral fracture with a retrograde intramedullary nailing. MATERIALS AND METHODS: We reviewed 13 cases (distal femoral shaft fracture: 6 cases, supracondylar fracture: 7 cases) of the distal femoral fracture who had been treated with retrograde intramedullary nailing and follow up for more than 12 months from January 1999 to December 2001. The rate of bony union, range of motion of the knee, complications were evaluated. RESULTS: The mean duration of bony union was 20 weeks (range, 16~25 weeks). A case of delayed union was developed. In 4 cases of 13 cases showed posterior angulation below 6 degree, which did not need further treatment. According to Saunder's criteria, excellent result was achieved in 8 patients, good result in 5 patients, respectively. CONCLUSION: This study showed good clinical and radiological results of union with retrograde intramedullary nailing at the distal femoral fracture and ipsilateral multiple fracture