ABSTRACT
Background: In the past two decades, the open reduction andinternal fixation has gained good result in the management ofdistal femur fractures. The present study has been undertakento evaluate the overall functional outcome of patients treatedby supracondylar nail.Materials and Methods: The present study was conducted atDepartment of Orthopaedics, Teerthanker Mahaveer MedicalCollege and Research Centre, Moradabad, UP, India. All thepatients admitted in the department of Orthopaedics withfracture distal femur and managed by intramedullarysupracondylar nail were included. Final assessment of resultswas done based on modified Mehrotra's grading based on theassessment of the final functional results and also taking intoconsideration, the complications if any.Results: Average duration between injury and surgery was3.38 days. In only 8% of the cases open reduction by additionalparapatellar incision was required. Average duration of surgerywas 52.6 minutes. Most common complication we encounteredwas knee stiffness in 16 cases followed by local symptom atdistal screw site in 12 cases. Superficial infection was seen in 9& deep infection in 2 cases. In 2 cases shortening was morethan 2.5 cm. Average range of movement at the knee joint inour series was 110.93 with 40 cases having full range ofmovement. Final results were excellent in 61 of the cases.Good in 23% Fair in 11%, Poor in 5%.Conclusion: Finally we conclude that intramedullarysupracondylar nail should be the treatment of choice for distalfemoral fractures. As it has all the advantages of closedtreatment like minimal blood loss, less soft tissue stripping,preservation of fracture haematoma and minimalcomplications. This operation is particularly suited for Type A,C1 & C2 types of fractures as shown by the final functionalresults of this study.
ABSTRACT
BACKGROUND: The osteosynthesis of the periprosthetic fractures following a total knee arthroplasty (TKA) can be technically difficult with the relatively small satisfactory outcomes and the high complication rates. The purpose of the study is to analyze the mid-term radiological and functional outcomes following the locked plating of the distal femur periprosthetic fractures after a TKA. METHODS: Records of 20 patients with a periprosthetic distal femur fracture following TKA treated by the locked plate osteosynthesis were retrospectively evaluated. The union rate, complications and functional outcome measures were analyzed. RESULTS: Successful union was achieved in 18 of the 19 patients available for the follow-up. The mean follow-up was 39 +/- 10 months. Significant reductions (p < 0.05) in the range of motion and Western Ontario and McMaster Universities Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were evident in the follow-up. Secondary procedures were required in 5 patients to address the delay in union and the reduced knee range of motion. The osteosynthesis failed in 1 patient who underwent a revision TKA. CONCLUSIONS: The satisfactory union rates can be achieved with the locked plate osteosynthesis in the periprosthetic distal femur fractures after TKA. Prolonged rehabilitation coupled with the un-modifiable risk factors can decrease the activity and satisfaction levels, which can significantly alter the functional outcome.