Evaluation of short term outcome on distal femoral fractures using distal femoral nail: revisiting the technique

Authors

  • Sandeep Kalia Department of Orthopaedics, DRPGMC Kangra, Sadarpur, Himachal Pradesh, India
  • Shalini Sharma Department of Anaesthesia, DRPGMC Kangra, Sadarpur, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20192133

Keywords:

Distal femur fracture, Distal femoral nail, Dynamization

Abstract

Background: Distal femoral fractures account for 6 to 7% of all femur fractures. Ideal treatment of these fractures demands indirect reduction as well as stable fixation by implant which could tolerate the stress and strain forces till healing of fracture. Distal femoral nailing fullfils these demands.

Methods: Fifteen patients with seventeen fractures were treated by this method as a prospective study at the tertiary care institute in north india. Patients were evaluated  post operatively with average follow up duration of 45.59±15.99 weeks.

Results: 88% of the patients were having associated trauma. Male/female ratio was 9/8. Mean delay in surgery was 21.86±23.85 days (1-64 days). Reduction was satisfactory in all patients. Average hospital stay was 18.71±8.23 days (6-34 days). Clinical union was seen in 16 out of 17 fractures by the end of six months with average period of 4.19±0.83 months. Radiological union lagged behind clinical union with average of 5.14±0.44 months. Post operatively 5 patients with delayed union needed dynamization, 2 needed  bone grafting . One case of non union was seen. There were two cases of  infection requiring debridement. Average knee flexion was 90.35±22.95degree (50-130 degree). Average extension lag was 3.88±2.88 degree (0-10 degree). Sanders function evaluation scale at final follow up showed 11.8% excellent, 47.2% good, 23.6% fair and 17.6% poor result.

Conclusions: Distal femoral nailing has good results in distal femur fracture  as the fixation is more biological and stable allowing early healing and better outcome

References

Armeson TJ, Melton LJ, Lewallen DC. Epidemiology of diaphyseal and distal femur fractures. Clin Orthop. 1998;234:188-94.

Siliski JM, Mahring M, Hoffer HP, Supracondylar Intercondylar fractures of femur. Treatment by internal fixation. JBJS. 1989;71:95-103.

Pritchett JW. Supracondylar fractures of femur. Clin Orthop. 1984;184:173-7.

Lucas SE, Seligson D, Henry SL. Intramedullary supracondylar nailing of femoral fractures. A preliminary report of GHS supracondylar nail. Clin Orthop. 1993;296:200-6.

Petsatodis G, Chatzisymeon A, Antonarakos P, Givissis P, Papadopoulos P, Christodoulou A. Condylar buttress plate versus fixed angle condylar blade plate versus dynamic condylar screw for supracondylar intra-articular distal femoral fractures. J Orthop Surg (Hong Kong). 2010;18(1):35-8.

Vandenbussche E, LeBaron M, Ehlinger M, Flecher X, Pietu G. Blade-plate fixation for distal femoral fractures: a case-control study. Orthop Traumatol Surg Res. 2014;100(5):555-60.

Harder Y, Martinet O, Barraud GE, Cordey J, Regazzoni E. The mechanics of internal fixation of fractures of the distal femur: a comparison of the condylar screw (DCS) with the condylar plate (CP). Injury. 1999;30:31-9.

Lucas SE, Seligson D Henery SL. Intramedullary supracondylar nailing of femoral fractures A preliminary report of GHS supracondylar nail. Clin Orthop. 1993;296:200-6.

Gellman RE, Paiement GD, Green HD, Coughlin RR. Treatment of supracondylar femoral fractures with a retrograde nail. Clin Orthop. 1996;332:90-7.

Janjing HM, Stockman B, Van Damme G, Rommens P. Retrograde intramedullary nailing prospective experience in patients older than 65 years. J Orthop Trauma. 1998;12:330-3.

Leung KS, Shen WY, So WS, Mui LT, Grosse A. Intramedullary nailing for supracondylar or intercondylar fractures of distal part of femur. JBJS. 1991;73:332-40.

Ito K, Grass R, Zwipp H. Internal fixation of supracondylar femoral fractures; comparative biomechanical performance of 95 degree angle blade plate and two retrograde nails. J Orthop Trauma. 1998;12:259-66.

Grass R, Biewener A, Rammelt S, Zwipp H. Retrograde locking nail fixation of distal femoral fractures with distal femoral nail. Unfallchirurg. 2002;105:298-314.

Kubiak EN, Fulkerson E, Strauss E, Egol KA. The evolution of locked plates. JBJS. 2006;88:189-200.

Markmiller M, Konrad G, Suddump N. Femur-LISS and distal femoral nail fixation of distal femur fractures: are there difference in outcome and complications? Clin Orthop Rel Res. 2004;426:252-7.

Chaitnya K, Raja VS. Current concept of management of supracondylar femur fracture: retrograde femoral nail or distal femoral locking plate. Int Surg J. 2016;3(3):1356-9.

Neer CS, Grantham SA. Supracondylar fractures in adults. JBJS. 1967;49:591-613.

Gustilo RB, Anderson JJ: Prevention of infection in treatment of one thousand and twenty five open fractures of long bones. JBJS. 1976;58:453-8.

Grass R, Biewener A, Endress T. Clinical investigation of distal femoral nail. Unfallchirurg. 2002;105:587-94.

Moed BR, Watson JT. Retrograde intramedullary nailing without reaming of fractures of femoral shaft in multiply injured patients. JBJS. 1995;77:1520-7.

Downloads

Published

2019-06-27

Issue

Section

Original Research Articles