Functional and radiological outcome following operative skeletal stabilisation with bone grafting in distal femur non-unions: a study of 21 patients

Abstract

INTRODUCTIONIn India, the number of road accidents are amongst the highest in the world. With an estimated 1,50,000 losing their lives on Indian roads every year. The number of non-fatal accidents with resulting long bone fractures is estimated to be in excess of 5 million each year. Although the number of health care centres, both government run and private owned is high, there are still a small but significant subset of people who throng to the native bone setters for their treatment inspite of the government's crackdown on such spurious centres. The main reason for this is the high cost involved in managing such fractures and the taboo associated with surgical correction. This in the recent past has shown a declining trend and more patients are attending fracture clinics and hospitals because of better medical insurance coverage (both government and private) and better patient awareness towards the complications associated with such native splinting. However we still encounter sporadic cases of either fracture malunion and non-unions in our clinical practice.Distal femur fractures show a bimodal age distribution. 1 They are mostly high velocity injuries in the young and domestic injuries due to osteoporosis in the elderly ABSTRACT Background: The study was done to assess the functional and radiological outcome after operative skeletal stabilisation with bone grafting in 21 patients who presented to us with distal femur non-unions. Methods: Between August 2008 and October 2015, 21 patients (M:F-14:7) with established non-unions of the distal femur were included. All patients presented to us with established non-union following treatment with a native bone setter using splints. There were 16 patients with AO Type A, 4 with AO Type B and one patient with Type C. All patients underwent open reduction, internal fixation with plate and screws and bone grafting. Serial follow-ups were done at 4,8, 12, 16, 20, 24 weeks and 6 monthly thereafter. Results: All 21 patients had complete fracture healing at average of 19 weeks . Knee flexion (ROM) improved from an average 16® pre-op to 66® post-operatively. There were no implant failure, infection or nonunions in our study. The Knee Society score improved from 54 pre-operatively to 74 post-operatively at last followup. Conclusions: Even in established non-unions, good results can be expected if good surgical technique is followed and with bone grafting satisfactory union rated can be achieved. Knee ROM also improves with dedicated postoperative rehabilitation.