AO type C distal femur fracture: results of operative management in 52 patients

Abstract

Background: Intraarticular distal femur fractures are severe injuries posses many challenges in management and associated large number of complications like infection, knee stiffness, delayed union, nonunion, instability, and post-traumatic arthritis. The advent of distal femur locking plate has improved the operative outcome of these fractures. Aim and Objectives: This retrospective study aimed to determine the functional, clinical and radiological outcome of AO type C distal femur fractures treated with distal femur locking plate. Level and type of study: Level 4, A retrospective study. Methods: We retrospectively reviewed 52 patients with AO type C distal femur fracture in our hospital between January 2010 to December 2017. Patients were selected according to strict inclusions criteria and operated distal femur locking plate through medial parapatellar or modified swashbuckler approach. The functional and radiological outcome were studied using NEER knee score. Results: Total 52 patients in which 38 males and 14 females with a mean age of 41.77 years, a mean follow up of 14.56 months were included in our study. According to AO classification, 12 patients of type C1 fracture, 14 of C2 fracture and 26 of type C3 fracture were included. Average time of union was 18.4 weeks and average NEER score at final follow up was 77.68 with 18 patients had excellent, 22 patients had satisfactory results, 7 were had fair results and 5 had poor results. The average range of flexion was 95.86. Conclusion: Distal femur locking plate is better to provide angular stability, multiple options to secure fracture fragments both metaphyseal and articular to restore limb length, joint congruity, and varusvalgus alignment. Along with the anatomical reduction of joint surface and rigid fixation, early mobilization and proper physiotherapy are mandatory to get the optimum outcome.

Swashbuckler approach for distal femur fractures: A systematic review

“…22 There are case reports of Hoffa's fracture being treated with a swashbuckler approach. 4 The study revealed that using the Swashbuckler approach doesn't increase the chance of nonunion. The rates of complications were also similar.…”

“…The rates of complications were also similar. 4,22 Ahire et al compared the current approach with the lateral approach in the treatment of the distal femur fractures with 30 patients in each group. The patients were followed up for 1 year wherein the author noticed union in all cases but the lateral approach group was seen to have more major complications and significantly lesser functional outcomes.…”

“…1,3 These approaches include anteromedial/anterolateral parapatellar approaches, Olerud extensile anterior approach, Anterior approach, Tibial tubercle osteotomy, Combined medial and lateral approach, Posterior approach, and Swashbuckler approach. 4,5 The most commonly used in clinical practice is the lateral parapatellar or anterolateral approach. 6,7 Distal femur fractures especially the AO type C require good intraarticular exposure for anatomic reduction.…”