RESUMO
Background- Fractures of distal femur are one of the most prevalent fractures encountered in high-velocity trauma which are associated with high morbidity and mortality if not managed well. The isolated fracture can itself lead to complications such as Acute Respiratory Distress and pulmonary embolism. This neccesitaties early stabilisation of the fractures. Open reduction and internal fixation (ORIF) with locking compression plate is the treatment of choice for closed fractures of the distal femur. Distal femur anatomic contoured locking compression plate (LCP) has shown to give one of the best results regarding recovery, fracture union, return to work and the functional outcome. We present our experience of management of distal femur fracture at our centre. Study Material and Methodsdone on 36 patients, (NEER'S Classification) age range of 18 to 70 years (irrespective of their sex), were subjected to fixation by locking compression plate after obtaining thorough written informed consent. The observational study was carried at our institute between June 2021 to June 2022 Patients of both gender who were skeletally mature are taken into the study. In 61.5% of patients up to 50 years old and in Results40% of patients older than 50 years, the functional evaluation of LCP using Neers criteria was excellent. There was no statistically significant (p>0.05) difference in patients' functional status according to their age group who had distal femur fractures, which were stabilise by LCP. For supracondylar femur fractures, locking compression plates is a safe technique that has a good functional outcome, early clinical and radiographic union, and few complications.
RESUMO
Treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections. The objective was to compare the functional and radiological outcome of fracture distal femur treated by open reduction with LCP by minimally invasive plate osteosynthesis (MIPO). We wanted to compare the clinical and radiological differences between open and MIPO techniques for distal femoral fracture fixation.METHODSThis was a prospective interventional study. 41 subjects with closed supracondylar femur fracture treated surgically from March 2013 to December 2017, were evaluated prospectively for functional and radiological outcome results after fixation with distal femoral locking compression plate in open or minimally invasive way, with minimum follow up of 1 year. IBM SPSS Ver. 25 software was used to perform statistical analysis.RESULTSThe mean age of 41 treated patients was 53.8 ± 13.7 years and ranged from 23 to 84 years. 19 patients were females and 22 were males. Mean time to surgery was 5.7 ± 2.9 days with minimum 2 and maximum of 18 days from injury. Initially 20 patients underwent open surgery and 21 patients were operated by minimally invasive plating technique. In all cases, a 316L stainless steel alloy distal femoral locking plate was used.CONCLUSIONSKnee ROM could be started at a mean of 1.4 weeks earlier in the MIPO group and this was statistically significant. The two groups did not differ significantly in start of full weight bearing. Knee flexion at 6 weeks was also comparable in the two groups. However, knee flexion was average 21.9° higher in MIPO group at 1 year which was significantly different than ORIF group. The proportion of patients with >90° and >110° knee flexion also varied significantly between the groups. VAS score in MIPO group was significantly less at 6 weeks but difference was non-significant at 1 year. There were 2 cases with non-union and implant failure in the ORIF group, but the proportion was not significant. There was 10° FFD in 1 patient of ORIF group, while varus deformity occurred in 3 patients of MIPO group. The proportion of deformity was not significantly different between the two groups.