Complex AO type C3 distal femur fractures: Results after fixation with a lateral locked plate using modified swashbuckler approach

Agrawal, Alpna; Kiyawat, Vivek

doi:10.4103/0019-5413.197516

Cited by 21 publications

(14 citation statements)

References 21 publications

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“…In a prospective study conducted by Agrawal A et al, 17 12 patients with distal femur fractures were operated with lateral locked compression plate and observed. Patients had a mean follow up of 17.6 months and 58.3 % patients had excellent outcome, 25% patients had fair outcome and 16.6% had fair outcome at one year follow up using knee society knee scoring system .…”

Section: Resultsmentioning

confidence: 99%

Functional Outcome of Fractures Distal End of Femur Using LCP – A Prospective Observational Study

Yadav¹,

Mohan²,

S³

et al. 2020

KJOrth

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Background: Trauma management is an ever evolving part of orthopaedics and with the latest advancement in metallurgy, crafting processes and biomechanical studies, the implants used have been continuously changing. Distal femur fractures occur at a major joint and their management has always been complicated ranging from preoperative, intra-op to postoperative period. All the studies and research are aimed towards achieving the best functional outcome and functional outcome studies help in collecting and assimilation of the data for the same which further help in modification of techniques to further improve the same. This study focusses on the outcomes achieved by using the distal femur locking compression plate for the management of fractures distal end of femur. Materials and Methods: Prospective, unicentric, observational study from June 2018 -February 2020. All patients with distal femur facture were included. Pathological fractures, open fractures, fractures older than 3 weeks and patients with ipsilateral proximal tibia, patella and proximal femur were excluded. Surgical approach was surgeon's choice. Functional outcome was measured using Knee Society Knee Scoring system at 6weeks, 3 months, 6months and 12 months. Functional outcome measured at 12 months was used for evaluation. Results: 28 patients, 19(67.9%) males and 9(32.1%) females. 89.47% of males sustained the fracture due to road traffic accident and 66.66% of females sustained due to fall and all belonged to age group more than 60 years. The average range of motion achieved was 112.3° ± 8.2. Functional outcome at 12 months 71.4% patients had excellent, 25% had good and 3.6% patients had fair and no patient had poor outcome. Conclusion:Distal femur fracture is more common in the age group of 21-40 years. The average range of motion of knee achieved in Type A and Type B fractures are significantly better than Type C fractures. Excellent functional outcome was statistically significant in Type A and Type B fractures when compared to Type C fractures.

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Section: Resultsmentioning

confidence: 99%

Functional Outcome of Fractures Distal End of Femur Using LCP – A Prospective Observational Study

Yadav¹,

Mohan²,

S³

et al. 2020

KJOrth

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“…For the treatment of distal thigh fractures good and clear guidelines already exist [ 28 – 30 ]. In this context, the classifiable treatment is established and well evaluated, too [ 24 , 31 , 32 ]. There are also many different classifications for the treatment of periprosthetic distal femoral fractures with clear therapeutic deductions [ 16 , 18 , 19 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, technical developments for the medical treatment of periprosthetic fractures in revision systems have become established. The successful clinical usage of different investigations such as retrograde intramedullary nails with angular stable locking options, plate osteosynthesis with multidirectional locking options or polyaxial locking compression plates (LCP) as well as attachment plates has also often been described in the literature [ 20 – 24 ]. Based on the increase of different types of prosthesis with an accumulation of revision systems and the development of new care strategies it is necessary to create a novel more extensive classification with a clear reference to the implant.…”

Section: Introductionmentioning

confidence: 99%

A new classification of TKA periprosthetic femur fractures considering the implant type

Fakler

Pönick

Edel

et al. 2017

BMC Musculoskelet Disord

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BackgroundThe treatment aims of periprosthetic fractures (PPF) of the distal femur are a gentle stabilization, an early load-bearing capacity and a rapid postoperative mobilization of the affected patients. For the therapy planning of PPF a standardized classification is necessary which leads to a clear and safe therapy recommendation. Despite different established classifications, there is none that includes the types of prosthesis used in the assessment. For this purpose, the objective of this work is to create a new more extensive fracture and implant-related classification of periprosthetic fractures of the distal femur based on available classifications which allows distinct therapeutic recommendations.MethodsIn a retrospective analysis all patients who were treated in the University Hospital Leipzig from 2010 to 2016 due to a distal femur fracture with total knee arthroplasty (TKA) were established. To create an implant-associated classification the cases were discussed in a panel of experienced orthopaedists and well-practiced traumatologists with a great knowledge in the field of endoprosthetics and fracture care. In this context, two experienced surgeons classified 55 consecutive fractures according to Su et al., Lewis and Rorabeck and by the new created classification. In this regard, the interobserver reliability was determined for two independent raters in terms of Cohen Kappa.ResultsOn the basis of the most widely recognized classifications of Su et al. as well as Lewis and Rorabeck, we established an implant-dependent classification for PPF of the distal femur. In accordance with the two stated classifications four fracture types were created and defined. Moreover, the four most frequent prosthesis types were integrated. Finally, a new classification with 16 subtypes was generated based on four types of fracture and four types of prosthesis. Considering all cases the presented implant-associated classification (κ = 0.74) showed a considerably higher interobserver reliability compared to the other classifications of Su et al. (κ = 0.39) as well as Lewis and Rorabeck (κ = 0.31). Excluding the cases which were only assessable by the new classification, it still shows a higher interobserver reliability (κ = 0.70) than the other ones (κ = 0.63 or κ = 0.45).ConclusionsThe new classification system for PPF of the distal femur following TKA considers fracture location and implant type. It is easy to use, shows agood interobserver reliability and allows conclusions to be drawn on treatment recommendations. Moreover, further studies on the evaluation of the classification are necessary and planned.

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“…Patients were operated under appropriate anaesthesia in supine position on a radiolucent table under image intensifier. Incision and approach to distal femur varied with the location of the open wounds which were liberally extended proximally and distally, except in cases of medial wound where the wound was extended for debridement only and standard lateral or modified swashbuckler approach was used in such cases 8 . Second inspection of the wound and radical debridement consisting of excision of devitalized tissues was done preserving the soft tissue envelope followed by definitive fixation with condylar locking plate following the principles of biological fixation.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen

Kumar

Singh

Khiyani

et al. 2019

Chinese Journal of Traumatology

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PurposeDistal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%–10% of the all distal femoral fractures, which is at an increased risk of complications. There were limited studies which documented the outcomes of such cases. The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.MethodsThis is a prospective study conducted in a tertiary care orthopaedic hospital in northern India. Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. They were followed for minimum of six months. Patients were followed up monthly for first four months, at six months and one year after surgery. Clinical and radiological signs of healing, any complications, time to union, and functional outcome were assessed.ResultsThe mean age of patients was 44.33 years (range 20–82 years) with male predominance of 66.7%. According to Gustilo-Anderson classification, there were 5, 15 and 10 patients with open grade I, II and IIIA distal femoral fractures respectively. According to orthopaedic trauma association (OTA) classification, majority of patients in our study were of C3 type. The mean time to bony union was 5.6 months (range 4–9 months). Average postoperative knee range of motion (ROM) at the latest follow-up was 98⁰ (range 70⁰-120⁰). Lysholm knee scoring scale showed excellent score in 11 patients, good in 9 patients, fair and poor in 5 patients each; however, there was no significant correlation with fracture pattern types (p < 0.05). Knee stiffness was the major complications encountered in the study. The knee ROM was <90⁰ in 5 patients and 90⁰-120⁰ in rest of the patients, while 1 patient had extensor lag of 10⁰. One patient had implant failure and lost to follow-up; 3 patients had deep infection.ConclusionAn approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.

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Complex AO type C3 distal femur fractures: Results after fixation with a lateral locked plate using modified swashbuckler approach

Cited by 21 publications

References 21 publications

Functional Outcome of Fractures Distal End of Femur Using LCP – A Prospective Observational Study

Functional Outcome of Fractures Distal End of Femur Using LCP – A Prospective Observational Study

A new classification of TKA periprosthetic femur fractures considering the implant type

Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen

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