Comparative study of distal femoral locking compression plate and tens nail versus lateral distal femur plate in management of distal femur fracture cases

Abstract

Background: The fracture of distal femur are often unstable and comminuted and as difficult to treat. The incidence of complications in these fracture are relatively high .The purpose of our study was aimed to compare functional outcome between both column fixations by using distal femoral locking compression pate on lateral side and then using TENS nail on medial side to obtain support of medial column versus lateral distal femoral plate. Methods: We have included 80 patients with distal femur fracture with intercondylar extension in our study. We have treated 40 patients with distal femoral locking compression plate and support of medial wall with TENS nail and 40 patients with distal femoral locking compression plate. There were sixty six males and fourteen females. The average age of the patients was 39.08 ± 11.95 years. All the patients were operated between 3 to 9 days. All patients were followed up at 2th, 6th, 10th weeks, 3 month and 6 month regularly and evaluated for fracture healing, Clinical union was defined as a painless fracture site during full weight bearing. Radiological union was defined as bridging trabeculation across the fracture site on three of four cortices. The final outcome was assessed according to schatzker and Lambert scoring system. Results: The result was excellent in twelve, good in fifteen, fair in ten and poor in one in DFLCP with TENS nail group according to schatzker and Lambert scoring system. The result was excellent in eight, good in twelve, fair in twelve and poor in five in DFLCP group according to schatzker and Lambert scoring system. The average time to Union was 17.7 weeks in DFLCP with TENS nail group and 19.9 weeks in DFLCP group. Complications include superficial wound infection in three patients, secondary osteoarthritis in 17 patients and varus angulation in three patients in DFLCP with TENS nail group. In DFLCP group varus angulation was in eleven patients. Conclusions: The use of TENS nail for medial femoral defect along with distal femoral locking compression plate may eliminate the need of plate on medial side. The varus angulation that occurs with defect is decreased and additional long incision and operative time is avoided.