Background: Distal femur fractures with intra-articular extension and comminution are challenging injuries, fraught with complications such as mal-union and stiffness. We prospectively evaluated and compared a consecutive series of patients with AO type B and C distal femur fractures to determine the clinico-radiological outcome after fixation with distal femur locking compression plate using Swashbuckler approach and standard lateral approach. Materials and Methods: 60 patients with AO Muller's type B and C distal femur fractures (mostly type C2 and C3) were treated with distal femur locking compression plate (DF-LCP), 30 patients using swashbuckler approach and 30 patients using standard lateral approach. The regular follow-up up to 1 year was done and results were determined using the Neer's Score. Results: All fractures united at a mean of 14.64 weeks (range 12-20 weeks). In our study mean duration of surgery for lateral approach group was greater (99.6min) than swashbuckler group (85 min). Mean ROM in swashbuckler group was 100.83 degree compared to 83.83 in lateral group. Mean Neer's score was 76.96 in lateral approach group compared to 81.83 in swashbuckler approach group. Complication rate was similar in both the group. Conclusion:The results of distal femur fractures using a swashbuckler approach are encouraging and comparable to standard lateral approach with a majority of patients achieving good to excellent outcome at 1 year especially in complex AO type C3 fractures.

Background: A bone fracture is a medical condition where the continuity of the bone is broken. Open fractures usually are high-energy injuries. This, along with the exposure of bone and deep tissue to the environment, leads to increased risk of infection, wound complications, and non-union [1,2] . Antibiotics, surgical debridement, and internal fixation have improved outcomes of open fracture management in important ways, and it includes primary asepsis, adequate debridement, immobilization, and protection of wounds against disturbance and reinfection [3,4] . Wound healing is a complex and dynamic process that includes an immediate sequence of cell migration leading to repair and closure. This sequence begins with removal of debris, control of infection, clearance of inflammation, angiogenesis, deposition of granulation tissue, contraction, remodeling of the connective tissue matrix and maturation. When wound fails to undergo this sequence of events, a chronic open wound without anatomical or functional integrity results. Vacuum assisted closure (VAC) is relatively a new technique which hastens granulation tissue formation by speeding up all these parameters [5] . Materials and Methods: The present study was Hospital based Prospective comparative study carried out from July 2016 to October 2018, on 90 cases satisfying the inclusion criteria following complete assessment. Patients were assessed by efficacy of both procedures was measured by the time taken by wound be optimal for skin grafting/flap, whether slough and discharge present or not, rate of decrease in size of wound (%) and whether flap is needed or avoided by use of VAC dressing Result: Both group are compare on the basis of type of fracture as per Gustillo and Anderson classification, duration of receiving treatment from initial injury, slough was comparable on day 0 and day 4, frequency of discharge, granulation tissue and size of wound. Conclusion: VAC therapy show final cessation of slow earlier than those treated by standard therapy for fracture management. VAC therapy shows earlier control of discharge, earlier appearance granulation tissue and earlier decrease in size of wound compare to standard therapy. Rate of healing is faster in VAC therapy compared to standard therapy. Earlier optimized covering of wound can be obtained by VAC therapy. Requirement of skin grafting is less in subjects treated with VAC therapy. Minimal complications with complete healing possible with VAC therapy in compound fractures of lower limb.

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