Published: 2020-10-22

Evaluation of minimally invasive plate osteosynthesis of distal femoral fracture by mini-open technique with femoral distractor and traction table: a prospective review of 26 cases

Tapas Kumar Ghosh, Rajeeb Banik, Bijoy Bhattacharjya


Background: Different methods exist for fracture reduction and submuscular plating in distal femur intra-articular and metaphyseal extra-articular fractures. Apart from knee flexion, femoral distractor and traction table are commonly used for alignment of fractures in minimally invasive techniques.

Methods: 26 distal femoral fractures (all closed fractures) were operated (14 cases in traction table, 12 cases in femoral distractor). Partial articular/unicondylar fractures were excluded from our study. Mean patient age was 42 years (range 18 to 60 years). Evaluation was done by knee society score (KSS).

Results: Mean time of radiological union was 23.2 weeks (range 20-28 weeks). 23 fractures united uneventfully, one patient had wound infection, and 2 cases had non-union with implant failure. Debridement in infected implant and re-fixation with long plate and bone grafting were done for fracture union in these two cases. According to KSS, excellent outcome were seen in 6 patients, 10 had good, 8 had fair and 2 had poor outcome.

Conclusions: Distraction by traction table or femoral distractor helps us to reduce the fracture by overcoming the pull of gastrocnemius in 2 week old fracture correcting hyperextension/recurvatum deformity. This method can be used as viable alternative in minimally invasive plating causing less chance of infection preserving maximal joint movement.



Submuscular plating, Femoral distractor, Traction table, Knee society score

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Higgins TF. Distal femoral fractures. J Knee Surg. 2007;20:56-66.

Weller S. Biological fracture fixation-what is this? Is it another traumatological fashion or an important aspect of operating technique?. IGOF News. 1997;1.

Miclau T, Martin RE. Evolution of modern plate osteosynthesis. Injury. 1997;28(1):3-5.

Egol KA, Kubiak EN, Fulkerson E, Kummer FJ, Koval KJ. Biomechanics of locked plates and screws. J Orthop Trauma. 2004;18:488-93.

Stoffel K, Dieter U, Stachowiak G, Gachter A, Kuster MS. Biomechanical testing of the LCP-how can stability in locked internal fixators be controlled?. Injury. 2003;34(2):11-9.

Babst R, Bavonratanavech S, Pesantez R. minimally invasive plate osteosynthesis second expanded edition. AO foundation, Switzerland. Thieme. 2012;421.

Leunig M, Hertel R, Siebenrock KA, Ballmer FT, Mast JW, Ganz R. The evolution of indirect reduction techniques for the treatment of fractures. Clin Orthop Relat Res. 2000;375:7-14.

Kregor PJ, Stannard JA, Zlowodzki M, Cole PA. Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures. J Orthop Trauma. 2004;18:509-20.

Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res. 1989;248:13-4.

Hontzsch D. Distal femoral fracture-technical possibilities. Kongressbd Dtsch Ges Chir Kongr. 2001;118:371-4.

Greiwe RM, Archdeacon MT. Locking plate technology: current concepts. J Knee Surg. 2007;20:50-5.

Hammer C, Afolayan J, Trompeter A, Elliott D. A novel approach to closed reduction of distal femur fractures. Ann R Coll Surg Engl. 2014;96(8):626-8.

Chandrasekaran M, Subbaraj R, Nandakumar R, Reddy KB. Distal femur fractures treated with MIPO locking compression plate technique: a prospective study on the functional outcome. Int J Orthop Traumatol Surg Sc. 2016;2(2):263-8.

Walia JPS, Malu G, Walia SK, Gupta AC, Sethi S, Singh S. Minimally invasive plate osteosynthesis for distal femoral fractures. JIMSA. 2014;27(4).

Kumar GNK, Sharma G, Farooque K, Sharma V, Ratan R, Yadav S, et al. Locking compression plate in distal femoral intra-articular fractures: our experience. Int Scholar Res Notices. 2014;1:1-5.