Kishore Babu S1, Pardhasaradhi M2
Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures. Nearly, 50% of distal femur intraarticular fractures are open fractures. Despite many changes and refinements in the surgical treatment of the supracondylar and intercondylar fractures of femur their surgical management remains challenging. Since the introduction of the condylar blade plate to the present retrograde supracondylar nailing and locking condylar plates, these fractures particularly if open and associated with severe fragmentation of the articular cartilage and in the elderly with severe osteoporosis continue to be a major unsolved surgical challenge. Improved imaging facilities rendered surgical results far better than those treated with long periods of traction on bed with accompanying complications. LCP along with isolated 6.5 mm cannulated cancellous screw systems are best suited for with unicondylar fractures of distal femur in young patient with good bone stock. The functional outcome is largely determined by the degree of accompanying soft tissue injury. Presence of a compound fracture leads to a higher incidence of infection. With good preoperative antibiotics and sterile surgical techniques along with stable fixation, infection can be brought under control and a good outcome can be achieved.
MATERIALS AND METHODS
Thirty supracondylar and intercondylar fractures of femur (Muller’s type ‘A’, type ‘B’ and type ‘C’ fractures), which were treated with open reduction and internal fixation by locking compression plate were included in the study. The study was conducted at the Department of Orthopaedics, King George Hospital, Visakhapatnam, from August 2014 to November 2016. Among 30 patients, 5 patients were lost for follow up due to various reasons leaving 25 fractures from 25 patients for the study.
There were 16 males and 9 females. Age range was 19 years to 80 years with an average of 44.6 years. Average age for males was 28.9 years and average age for females was 25 years. 18 fractures were due to road traffic accidents and 5 were due to fall from varying heights. One case was due to bullet injury (classified as Gustilo Anderson type IIIB as it was a high velocity ballistic injury). We used Gustilo Anderson classification to classify open fractures. Among 25 cases, there were 3 compound fractures (12%) and in them 1 case was type 1 compound fracture (4%), 1 case was type II compound fracture (4%), another case was type IIIA compound fracture (4%). Fractures included in this study were Muller’s type A, B and C fractures. Subgroups are type A1- 7 cases, A2- 5 cases, type A 3-4 cases, type B1- 1 case, type B2- 3 cases, type C1- 4 cases, type C2- 2 cases. There were no associated ligamentous injuries of knee, but there were ipsilateral fractures of both bones of leg, fractures of humerus and fractures of both bones of forearm. There were no tibial condylar fractures. Majority of the associated fractures were treated simultaneously. No vascular injuries were noted in this series. The average time between admission and operation was 7.3 days (range 5 days to 16 days). Delay in the operation for more than one week was attributable to multiple trauma and poor general condition of the patient. All these patients were involved in high energy trauma like road traffic accidents or fall from height and most of the patients came within hours of accidents (maximum was 2 days).
Standard open reduction and internal fixation with LCP is a very good method of treating distal femur fractures including the Muller/AO C3 variety. Soft tissue injury and intraarticular comminution compromised the patient outcome. Functional assessment with either Neer’s or Sanders functional scoring systems have been found useful in evaluating the results. Favourable results can be obtained with strict adherence of principles of stabilisation with rigid internal fixation and early functional rehabilitation. LCP proved to be a good implant, which could take the challenges like poor bone stock, severe comminution both metaphyseal and articular. ORIF of distal femoral fractures with LCP coupled with properly timed early and optimal rehabilitative protocol yields excellent and good results.