Management of Distal Femoral Fracture with Distal Femoral Nail

Abstract

Background: For a long time distal femur fracture were considered difficult to heal and often led to a degree of disability. The incidence of malunion, nonunion and infection are relatively high in many reported series. The management goal of distal femur fractures are correction of axial alignment, length, and rotation, restoration of motion and rapid union so as to return the patient to normal function. We present here result of retrograde nailing of extra-articular (AO 33A1 to A3) fractures of the distal femur using Distal Femoral Nail (DFN). Methods: In Between 2008 to 2010 total 17 patients (One lost to follow up so 16 available for final assessment) underwent open reduction and internal fixation for distal femoral fracture in Chittagong Medical College Hospital and Private Hospital in Chittagong city. There were 13 male and 3 female patients, age range from 18 years to 70 years, mean age 42.75 years. Average length of follow-up was 17.5months (12 months to 24 months). Results: Total 16 patients was available for follow up. Regular fracture healing was observed in 14 cases. Delayed union in 2 case. One patient had infection, and two patients had leg shorting of 0.5 and 1 cm. Axial misalignment (Varus/valgus angulations) was found in 4 cases (5º-10º) there were no implant failures. On the bases of a Leung score to measure functional outcome, 4 cases had excellent, 8 cases had good and 4 cases had fair result. Poor results were not seen in any patient. In this series 13 cases were satisfactory and 3 cases were unsatisfactory. Conclusion: Distal Femoral Nail is handsome tool to treat distal femoral fracture.

Prospective study of functional outcome of distal femur fracture managed by distal femur nailing

“…12 No non-union occurred in present series. Similar finding was found in the series of Gellman et al, Jahangir et al, and Loya et al 5,8,11 But Anaberu et al, Handolin et al found non-union of 2.65% and 4.7% cases respectively in their series. 12,13 A study by Dileep et al showed 3 (14.3%) cases of delayed union.…”

“…This was comparable with the study conducted by Loya et al, Jahangir et al where mean duration of fracture union was 16 weeks and 15.81 weeks respectively. 5,8 100 percent of the fractures were healed in our study. Similar findings were seen in series of Gellman et al, Jahangir et al, Loya et al and Dileep et al 5,8,9,11 But in the series of Handolin et al 95% of the fractures were healed in regular healing time (less than 24 weeks).…”

“…5,8 100 percent of the fractures were healed in our study. Similar findings were seen in series of Gellman et al, Jahangir et al, Loya et al and Dileep et al 5,8,9,11 But in the series of Handolin et al 95% of the fractures were healed in regular healing time (less than 24 weeks). 12 No non-union occurred in present series.…”

“…This was comparable with the result of Jahangir et al and Gellman et al where the mean range was found to be 115º and 106º respectively. 8,11 Full weight bearing in the present series was observed at an average 12.64 (8 to 20) weeks. This was closely comparable with the series by Loya et al where full weight bearing was achieved on an average in 11.68 weeks.…”

“…Of all femoral fractures, distal femur fracture comprises of 4-6%. 8 In general population, bimodal distribution of distal femur fracture is seen. It is predominantly seen in 15-50 years of age males, sustaining high-energy trauma, and above age 50 years predominantly in females, with osteoporosis, sustaining relatively low energy trauma.…”