A Functional Evaluation Study of Distal Femoral Fractures Fixed With Distal Femoral Locking Plate

Abstract

BACKGROUNDFractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. . The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer's scoring system. 1 RESULTSTwenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients were with fracture on right side and 8 on left side. 3 patients had associated injuries. Of them, 2 patients had comminuted fracture of patella on same side and 1 had ipsilateral tibial fracture. All patients were treated with open reduction and internal fixation. All patients were operated within 8 days. Average time duration of surgery was 101 minutes with shortest duration being 80 mins. and longest being 120 mins. The size of plate was selected based on the type of fracture. Of 20 patients, 14 patients (70%) showed radiological union within 18 weeks. No patients had implant failure. Average flexion achieved in this study was 105 degrees with more than 45% patients having knee range of motion more than 110 degrees. Average knee extensor lag in this study was 5.8 degrees. Out of 20 patients, 3 had shortening, 2 patients with shortening of 15 mm and 1 shortening of 10 mm. In this study, 3 patients had significant virus and 3 patients had valgus malalignment with 2 patients had deep infection, which was treated with debridement and antibiotics. The duration of follow-up ranged from 3 months to 18 months. CONCLUSIONLocking compression plate is the optimal tool for many fractures in distal femur. It provided rigid fixation in that region of the femur, where a widening canal, thin cortices and frequently poor bone stock, which make fixation difficult. Min...