DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20170783

A study of surgical management of distal femoral fractures in adults using locking compression plate

Srinivas Bachu, Ramulu L

Abstract


Background: The introduction of locking compression plates with option of locked screws has provided the means to increase the stability of fracture fixation.

Methods: In this study, 30 distal femoral fractures were treated using the distal femoral locking compression plate. All fractures were fresh, closed and operated within 12 days. Follow up duration ranged from 6 to 18 months.

Results: In this study, 20 patients were males and 10 were females. The 23 of the fractures (76.66%), were caused by road traffic accidents, 3 were due to accidental falls (10%), one was due to assault and 3 were due to fall from height.9 patients had associated injuries.  All patients were treated with open reduction and internal fixation using Locking Compression Plate. 6 to 9 holed plates were used. Out of 30 patients 2 went for delayed union and 3 went for non-union. Average knee flexion was 109o having knee range of motion more than 100 with 50% patients. Average knee extensor lag was 2.4 degrees with only 4 patients with lag more than 5. 2 patients developed 2 cm shortening. 4 patients had less than 5 degrees of malalignment. 2 patients had deep infection. Functional outcome was measured using NEER's scoring system and was done at the end of 5- 7 months (average of 6 months).  Excellent results- 17 (56.66%) good results-8 (26.66%) fair results-2 (6.66%) poor results-3 (10%).

Conclusions: LCP condylar plate represents an evolutionary approach to the surgical management and is an important armamentarium in distal femur fracture fixation, especially when fracture is severely comminuted and in situations of osteoporosis. 


Keywords


Distal femoral fractures, Locking compression plate, Knee flexion, Knee extensor lag

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References


Arneson TJ, Melton LJ 3rd, Lewallen DG, O'Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota,1965-1984. Clinorthop. 1988;234:188-94 .

Martinet O, Cordey J, Harder Y, Maier A, Bühler M, Barraud GE. The epidemiology of fractures of the distal femur. Injury. 2000;31(3):62-3.

Schandelmaier P, Partenheimer A, Koenemann B, Grun OA, Krettek C. Distal Femoral Fractures and LISS Stabilization. Injury. 2001;32:55-63.

Michael Z, Mohit B, Marek DJ, Cole PA, Kregor PJ. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989-2005). J Orthop Trauma. 2006;20:366-71.

Kregor PJ, Stannard J, Zlowodzki M, Cole PA, Alonso J. Distal femoral fracture fixation utilizing the Less Invasive Stabilization System (L.I.S.S.): The technique and early results. Injury. 2001;32:32-47.

Schutz M, Muller M, Regazzoni P, Hontzsch D, Krettek C, Van der Werken C, et al. Use of the Less Invasive Stabilization System (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study Arch Orthop Trauma Surg. 2005;125(2):102-8.

Kolb K, Grutzner , Koller H, Windisch C, Marx F, Kolb W. Condylar plate for treatment of distal femur fractures : a long – term follow - up study. Injury. 2009;40(4):440-8.

Davison BL. Varus collapse of comminuted distal femur fractures after open reduction and internal fixation with a lateral condylar buttress plate. Am J Orthop. 2003;32(1):27-30.

Heather V, Theresa H, John S. Failure of LCP condylar plate fixation in the distal part of the femur. J Bone Joint Surg. 2006;88:846-53.

Neer CS, Gratham SA, Shelton ML. Supracondylar fractures of adult femur. JBJS. 1967;49(4):591-613.

Yeap EJ, Deepak AS. Distal Femoral Locking Compression Plate Fixation in Distal Femoral Fractures: Early Results. Malaysian Orthop J. 2007;1(1):12-7.

Henderson CE, Kuhl LL, Fitzpatrick DC, Marsh JL. Locking plates for distal femur fractures: is there a problem with fracture healing? J Orthop Trauma. 2011;25(1):8-14.

Hoffmann MF, Jones CB, Sietsema DL, Tornetta P 3rd, Koenig SJ. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. J Orthop Surg Res. 2013;8:43.