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
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20204583Keywords:
Submuscular plating, Femoral distractor, Traction table, Knee society scoreAbstract
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.
References
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.