The Outcome of Fixing Distal Femur Periprosthetic Fracture around Total Knee Replacement using a Locking Plate Non-Contact Bridging (NCB)

@#Introduction: Surgical fixation of peri-prosthetic distal femur fractures around knee replacements poses a challenge, especially in frail patients, with variable outcomes reported in the literature. This study looks at the outcomes of a consecutive series of patients presenting with such fractures and treated by using a locking plate fixation. Materials and methods: A total of 21 consecutive patients who were admitted to our trauma unit over 31 months and underwent fixation with the Non-Contact Polyaxial Locking plate system were retrospectively identified and their acute treatment with follow-up outcomes were analysed. Results: The mean age was 81 years and 71% were in ASA grades 3 and 4. Fracture morphologies were classified as per the Su classification, yielding 8 (38%) classified as Su one, 4 (19%) as Su two, and 9 (43%) as Su type three. Postoperatively, 2 patients (9.5%) died due to hospital-acquired pneumonia, and another 2 patients (9.5%) developed wound infections necessitating further return to theatre. Additionally, 2 (9.5%) patients had distal femoral replacements due to non-union. Mean discharge time was 28 days with 12 patients (55% of patients) starting protected weight-bearing six weeks after surgery. Conclusion: The incidence of morbidity, mortality was significant and re-operation was required in patients treated as described, and these were partly attributed to the patient’s average age and the pre-existing comorbidities. Significant variations were noted in the time to discharge, rehabilitation, and time to achieve fracture union. However, the majority of fractures did eventually unite. Patients with comminuted fractures and insufficient bone stock are more likely to progress to non-union and end up requiring revision knee arthroplasty.

Changes of bone mineral density in distal femur and proximal tibia in patients with spinal cord injury / 中国康复理论与实践

ObjectiveTo investigate the changes of bone mineral density of distal femur and proximal tibia in patients with spinal cord injury. MethodsNine inpatients with spinal cord injury in Beijing Bo'ai Hospital for rehabilitation from November, 2018 to January, 2021 were recruited. The bone mineral density of distal femur, proximal tibia, total hip and femoral neck at admission and six months after admission was measured. ResultsCompared with the results of admission, the bone mineral density of distal femur, proximal tibia, total hip and femoral neck decreased significantly six months after admission (∣Z∣ > 2.265, P < 0.01). The percentage of decreased bone mineral density in the femoral neck was inversely correlated with the lower extremity movement score at the second measurement (r = -0.515, P = 0.035). ConclusionWithin one year after the onset of spinal cord injury, the bone mineral density of distal femur and proximal tibia decreases.

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.

Algunas consideraciones sobre la trocleoplastia del fémur / Some considerations on the trochleoplasty of distal femur

La mala alineación patelofemoral tiene múltiples causas anatómicas y una de ellas es la displasia de la tróclea del fémur distal, por lo cual su tratamiento depende de varios factores. Para profundizar en los elementos esenciales de la técnica de trocleoplastia, se realizó una revisión bibliográfica exhaustiva donde se analizaron algunos aspectos de interés, a saber: clasificación más empleada para las displasias de la tróclea, elementos imagenológicos más importantes, indicaciones de la técnica quirúrgica, contraindicaciones, principales modalidades de trocleoplastia y vías de acceso quirúrgico. Se concluyó que este es un proceder con indicaciones muy específicas y puede realizarse mediante cirugía abierta o por vía artroscópica.

The poor patellofemoral alignment has multiple anatomical causes and one of them is the dysplasia of the distal femur trochlea, reason why its treatment depends on several factors. To deepen in the essential elements of the trochleoplasty technique, an exhaustive literature review was carried out where some aspects of interest were analyzed, that is: most used classification for the trochlear dysplasias, most important imagenologic elements, indications of the surgical technique, contraindications, main modalities of trochleoplasty and surgical approaches. It was concluded that this is a procedure with very specific indications and can be carried out by means of open surgery or arthroscopic way.

Expanding the horizons of clinical applications of proximal humerus locking plates in the lower extremities: A technical note / 中华创伤杂志(英文版)

Pre-contoured anatomical locking plates were designed to address the clinical need of fixing small epiphyseal segments with a larger number of screws. Those plates match the contour and shape of a variety of bones allowing for optimal buttress properties. The aim of this manuscript is to highlight the benefits of applying proximal humerus locking plates in the fixation of lower extremity bones. Although designed for the proximal humerus, the low-profile plate shape and anatomic contour also provides versatile use in certain areas of the lower extremity. This technical narrative highlights the versatile and reliable use of this plate for other anatomical areas than the one to which it has been originally conceived.

Application of rotationplasty in treatment of osteosarcoma of distal femur in children / 中国修复重建外科杂志

Objective: To investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children. Methods: A clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed. There were 7 boys and 3 girls with an average age of 6.7 years (range, 4-10 years). There were 4 cases of osteoblastic osteosarcoma, 4 cases of mixed osteosarcoma, and 2 cases of chondroblastic osteosarcoma. All children were staged as Enneking stage ⅡB. The disease duration ranged from 3.5 to 6.0 months (mean, 4.6 months). The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society (MSTS93), Toronto Extremity Salvage Score (TESS), and knee mobility were used to evaluate postoperative function. Tumor recurrence and metastases were monitored by radiograph. Results: Poor superficial incision healing occurred in 1 patient, and healed after dressing change. The other incisions healed by first intention. All children were followed up 24-72 months (mean, 52.6 months). No local recurrence was observed during follow-up. Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome, 1 alive with tumor, and 1 tumor free survival. Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy. The fracture healing time was 2.5-5.0 months (mean, 3.5 months). All children could walk independently at 4 months postoperatively. At last follow-up, the MSTS93 score was 19-25 (mean, 22) and the TESS score was 87-93 (mean, 90). The extension of knee joint mobility with artificial limbs was 0°-10° (mean, 5°), and the flexion of knee joint mobility with artificial limbs was 85°-95° (mean, 90.5°). Conclusion: Rotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life, and it can be used as an alternative to amputation.

Functional Outcome Analysis of Fracture distal end femur treated with distal femur LCP - A Prospective Study

Supra-condylar and inter-condylar fractures of the distal femur historically have been difficult to treat. They account for 7% of all femoral fractures. If hip fractures are excluded, 31% of femoral fractures involve distal portion. Because of the proximity of these fractures to the knee joint, regaining full knee motion and function may be difficult. Many of these fractures are the result of high energy trauma which generates severe soft tissue damage and articular and metaphyseal comminution, the management of which still remains complex and challenging to the orthopedic surgeons. The incidences of mal-union, non-union and infection are relatively high. Methods: A total of 25 patients were enrolled for this prospective study and all were treated with locking compression plate. Physical examination and radiographs were performed at regular follow-ups. Functional outcomes were analyzed using Modified Hospital for Special Surgery scoring system. Results: Patients were followed up every 2 weeks in the first month, then monthly for 3 months and then once every 3 months. The average range of knee flexion achieved was about 101°. The average knee score was 88.88 rated using Modified Hospital for Special Surgery functional score.The difference in knee range of motion was statistically significant for closed and open fractures but knee score and age was not statistically significant. Intra-articular fractures tend to have poorer results with respect to pain and function, more so because of the nature of the injury rather than the implant used, which limits the movement and causes loss of strength more than instability. Conclusion: The outcome seems to correlate with fracture severity, anatomic reduction, etiology, bone quality, length of time elapsed from injury to surgery, concomitant injuries and the exact positioning and fixation of the implant. Furthermore, the initial severe concomitant cartilage damage may predispose to early osteoarthritis although there is no evidence of that. Closed fractures have a higher range of motion as well as a better knee score as compared to open fractures thereby showing that soft tissue compromise also affects range of motion and further rehabilitation of the limb.

Management of Fracture Distal Femur Using Retrograde Supracondylar Nail: A Prospective Analysis at a Tertiary Care Centre

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.

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.

Locked Plating in Elderly Patients with Distal Femur Fracture: How to Avoid Complications?

Distal femur fractures in elderly patients with osteoporosis are complicated because poor bone quality makes screw purchase and fixation less secure, presenting many clinical challenges to the orthopedic surgeon. Minimally invasive locked plating using an angularly stable locking compression plate has become an integral tool for achieving secure fixation in osteoporotic distal femur fractures with improved biomechanical performance. On the other hand, complications, such as implant failure and periplate fracture, have still occurred. This paper describes the principles of internal fixation in minimally invasive lateral locked plating in elderly patients with osteoporotic distal femur fractures as well as how to avoid complications.

Results after Less Invasive Locking Plating in Intra-Articular Fractures of the Distal Femur

PURPOSE: The purpose of this study was to determine the clinical outcomes after a less invasive locking plating technique in intra-articular fractures of the distal femur. MATERIALS AND METHODS: This was a retrospective 19 case series of patients with distal femoral intraarticular fractures treated with a less invasive locking plating technique in a single center (Dankook University Hospital) from June 2010 to April 2016. Nineteen patients (11 males and 8 females) with a mean age of 55.9 years were enrolled. The functional outcomes were evaluated using the visual analogue scale (VAS), range of knee joint motion (flexion & extension), and Knee Society score. The radiology outcomes were evaluated with parameters measured in a plain radiograph (deviation angle of alignment axis on coronal and sagittal plane, mechanical lateral distal femur angle). RESULTS: The mean follow-up period was 26.4 months (range, 12–72 months) and the mean duration to union was 15.94 weeks (range, 11–28 weeks). The mean VAS was 1.36 (range, 0–8) and the range of motion of the knee joint was extension 4.73° (range, 0°–30°) and flexion 107.36° (range, 60°–135°). The mean Knee Society score was 85.47 (range, 47–100). The mean deviation angle of the coronal alignment axis was 4.07° (range, 1.3°–8.8°), the mean deviation angle of the sagittal alignment axis was 3.23° (range, 0.7°–7.0°), and the mechanical lateral femoral angle was 87.75° (range, 82.8°–95.5°). Six patients had traumatic osteoarthritis at the final follow-up. CONCLUSION: The purpose of this study was to evaluate the clinical and radiologic outcomes of intraarticular fractures of the distal femur in patients who underwent an anatomical reduction through an open reduction, and converted to an extra-articular fracture with rigid internal fixation. The results were relatively satisfactory.

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.

Analysis of oncological prognosis and survival of prosthesis after surgery for distal femoral malignant tumors / 肿瘤研究与临床

Objective To investigate the oncological prognosis, prosthesis survival rate and other related factors after limb salvage surgery for distal femoral malignant bone tumors. Methods A total of 42 patients who received the surgery of resection of malignant bone tumor of distal femur and prosthesis replacement of knee joint tumor in the Second Hospital of Shanxi Medical University from January 2008 to December 2013 were retrospectively analyzed. The patient's oncological prognosis, prosthesis survival rate and related influencing factors were analyzed. Results The follow-up period was 18-97 months. Of 42 patients with malignant bone tumors, 21 cases (50％) survived without tumor, 7 cases (16％) survived with tumor, and the 5-year overall survival rate was 66％. The overall survival rate of patients with Enneking stage ⅡB tumor was 55.4％, and that of patients with stage ⅡA tumor was 75.0％, and the difference was statistically significant (χ2= 4.350, P= 0.037). The survival rate of artificial prosthesis was 78.6％ (22/28), the different length of osteotomy affected the survival rate of prosthesis (χ2= 4.248, P= 0.039), but the different types of prosthesis did not affect the survival rate of prosthesis (χ2= 2.177, P= 0.140). Conclusions The distal femoral malignant bone tumor has a good oncological prognosis after limb salvage surgery, Enneking staging is an important factor affecting the oncological prognosis. The different length of osteotomy at the distal femur affects the survival rate of the prosthesis, the longer the prosthesis, the lower the survival rate of the prosthesis.

Principios quirúrgicos y biomecánicos de los métodos de fijación actual en el tratamiento de fracturas de Hoffa / Surgical and biomechanical principles of current fixation methods, in treatment of Hoffa fractures

Las fracturas de los cóndilos femorales en el plano coronal (Hoffa), son lesiones que afectan directamente la biomecánica de la rodilla. Están expuestas a un factor intrínseco de inestabilidad causado por el compromiso de los ligamentos y tendones insertados al fragmento condilar fracturado y a un factor extrínseco de inestabilidad dependiente del estrés mecánico en varo/valgo durante la fase de apoyo de la marcha y movimientos de flexo-extensión. El tratamiento quirúrgico con tornillos canulados sólo permite la compresión interfragmentaria y cierto grado de estabilidad rotacional, sin embargo, ese tipo de fijación podría no ser suficiente para soportar o neutralizar las cargas. Distintos autores han publicado otros métodos de osteosíntesis con el uso de placas en el plano lateral o posterior más la colocación de tornillos en sentido postero-anterior, pero siguen siendo opciones controversiales debido al tipo de morbilidad inherente a cada constructo. El objetivo de este artículo es realizar una revisión de la literatura para analizar la validez de los principios quirúrgicos y biomecánicos en el tratamiento de fracturas tipo hoffa.

Coronal plane fractures of the femoral condyles are commonly known as Hoffa fractures. These are intraarticular fractures that directly affect the biomechanics of the knee and have intrinsic and extrinsic instability patterns. The tendons and ligaments that remain attached to the condylar fragment produce the intrinsic instability. The extrinsic instability is due to the varus/valgus stress applied during the stance phase in the gait cycle as well as the flexion-extension movements. Surgical treatment with cannulated screws only achieves interfragmentary compression and certain amount of rotational stability that is not enough to support or neutralize the loads. Some authors have published different methods of osteosynthesis with lateral or posterior plates in conjunction with screws implanted in the posterior-anterior direction, still these techniques remain controversial due to the morbidity inherent to each construct. The purpose of this article is to review the current concepts of Hoffa fractures including biomechanics and surgical principles with the intention of analyzing their treatment efficacy.

Factors Affecting Posterior Angulation in Retrograde Intramedullary Nailing for Distal Femoral Fractures

PURPOSE: To analyze the factors that cause a posterior angulatory deformity in the retrograde intramedullary nailing of distal femoral fractures. MATERIALS AND METHODS: Fifty-five patients with distal femur fractures who were treated with retrograde intramedullary nailing were enrolled in this study. They were followed-up for at least one year postoperatively. The posterior angulatory deformity was evaluated according to the fracture location, pattern, and insertion point and the insertion point was compared with the ideal point derived from the radiographs of 100 normal adults. The correlation between the posterior angulation and the entry point of the nail was analyzed. RESULTS: The posterior angulation was similar in terms of the fracture location; a meaningful difference was noted among the fracture patterns (p=0.047). The posterior angulation was significantly greater when the entry point was located more posteriorly, accepting a malreduced state (p=0.012). CONCLUSION: Posterior angulation was smaller in the transverse fracture and the posterior location of the entry point from the apex of the Blumensaat's line increased the posterior angulation.

Locking Mechanism Failure after Distal Femoral Reconstruction with Modular Universal Tumor and Revision System (MUTARS) Tumor Prosthesis / 대한정형외과학회잡지

PURPOSE: We have used Modular Universal Tumor and Revision System (MUTARS) tumor prosthesis to reconstruct segmental resection defect of the distal femur. The purpose of this study was to evaluate the incidence and pattern of locking mechanism breakage and its correlation with other clinical variables. MATERIALS AND METHODS: We retrospectively reviewed 94 patients who were followed-up for more than one year after tumor prosthesis replacement (MUTARS) between 2008 and 2013. We examined the incidence and timing of locking mechanism (PEEK-OPTIMA) failure. We also evaluated the clinical characteristics of patients experiencing locking mechanism failure and compared them with those of other patients. RESULTS: At a mean follow-up of 55 months, we observed locking mechanism failure in 10 of 94 patients (10.6%). The mean age of patients with locking mechanism failure was 29 years (range, 13-54 years); the mean weight and height were 169 cm (range, 151-181 cm) and 67 kg (range, 53-89 kg), respectively. The mean body mass index was 23.5 kg/m² (range, 20.5-29.4 kg/m²). The median time interval between replacement and locking mechanism failure was 26.5 months (range, 12-72 months). The mean body weight of patients with failure was higher than that of patients without failure (p=0.019). CONCLUSION: The incidence of locking mechanism (PEEK-OPTIMA) failure after distal femoral reconstruction with MUTARS was 11%, and there was a correlation between failure and body weight of patients. Advancements in the design and material of locking mechanisms are warranted to reduce the complication.

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.

Medial Plating of Distal Femoral Fracture with Locking Compression Plate-Proximal Lateral Tibia: Cases' Report

Generally, lateral plating is used for a comminuted fracture of the distal femur. However, in some cases, it has been shown that using a medial plate is necessary to achieve better outcome. Nevertheless, there are no available anatomical plates that fit either the distal medial femoral condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. We found that locking compression plate-proximal lateral tibia (LCP-PLT) fits anatomically well for the contour of the ipsilateral medial femoral condyle. Moreover, LCP-PLT has less risk of breaking the thread holes since it rarely needs to be bent. We report a plastic bone model study and two cases of distal femoral fractures fixed with medial plating using LCP-PLT.

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.

Three Dimensional Morphometry of Distal Femur to Design Knee Prosthesis for Indonesian Population / Morfometría Tridimensional del Fémur Distal para Diseñar Prótesis de Rodilla para la Población Indonesia

The objective of this study was to design custom-made prosthesis in a certain population, the morphometry needs to be measured. The results of this study were expected to provide basic data to design the ideal size of the total knee arthoplasty prosthesis for Indonesian population. This was an anthropometric study conducted on 100 healthy Indonesian population based on Computer Tomographic (CT) imaging on the distal femur resected surface. The parameters being used were Femoral Medio Lateral (fML) length, Femoral Antero Posterior (fAP) length, Femoral Medial Antero Posterior (fMAP) length, Femoral Lateral Antero Posterior (fLAP) length, and Femoral Aspect Ratio (FR). We found that the mean fAP and fML were 54.60±5.71 and 65.98±6.51, respectively. The morphometry of the distal femur were significantly different between male and female (male have larger build), however one of parameters showed different result: fLAP. This study showed that Indonesian people have smaller build compared with their Western counterpart. The proposed dimensions can be used as the basic data to design the ideal size of the custom-made knee arthoplasty prosthesis for Indonesian population.

El objetivo fue diseñar una prótesis a medida para una determinada población, por tanto la morfometría debía ser medida para proporcionar datos básicos para diseñar el tamaño ideal de una prótesis total para la artroplastia de rodilla en población de Indonesia. Se realizó un estudio antropométrico sobre 100 sujetos sanos indonesios, basados en tomografías computadorizadas (TC) de la superficie resecada del fémur distal. Los parámetros que se midieron fueron longitud femoral mediolateral (FML), longitud femoral anteroposterior (FAP), longitud femoral medial anteroposterior (FMAP), longitud femoral lateral anteroposterior (FLAP), y razón de aspecto femoral (FR). Las medias FAP y FML fueron 54,60±5,71 y 65,98±6,51, respectivamente. La morfometría del fémur distal fue significativamente diferente entre hombres y mujeres (mayor tamaño en hombres), sin embargo uno de los parámetros mostró resultados diferentes, la FLAP. Las personas indonesias son de menor tamaño en comparación con su contraparte occidental. Las dimensiones propuestas se pueden utilizar como los datos básicos para diseñar el tamaño ideal para una prótesis de rodilla a medida para la población de Indonesia.