Epidemiology and Treatment of Distal Femoral Fractures in Adults

Background: Distal femur fractures need to be treated operatively to achieve optimal outcomes. Different types of internal fixation devices have been used but, the number of revisions for non-union, loss of reduction and implant failure has been high.Methods: This prospective study reviewed 20 cases of distal femoral fractures surgically managed with distal femoral locking compression plate between December 2013 and December 2015 at Mediciti Institute of medical sciences, Ghanpur, Medchal, tertiary care referral and trauma centre. Fractures were categorized according to OTA classification by Muller.Results: Highest number of patients was in their 3rd decade (25%) 18 out of 20 patients had closed injury. Type A2 Muller’s fracture was the most common fracture type 7 out of 20 patients (35%).The mean follow up period in this study was 8 months. The average range of knee flexion achieved was about 109°. The mean score 81.75 points were rated using Neer’s functional score (Max 100). Conclusions: The locking compression plate is the treatment of choice in the management of comminuted distal femoral fractures especially Type A fractures where we have found higher Neer scores. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is valuable in the management of these fractures.

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“…1,2 Bimodal age distribution is seen. Peak incidence is seen in patients below 40 years of age, commonly males, experiencing high-energy trauma.…”

Section: Introductionmentioning

confidence: 99%

Management of distal femur fractures with locking compression plate: a prospective study

Konuganti

Jakinapally

Rao³

et al. 2018

Int J Res Orthop

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“…Treatment options for these injuries include non-operative management but carries a higher risk of non-union (over 30%) and the risks of immobilisation, 2,3 and reconstruction with such implants as the intercondylar blade or screw plate, [4][5][6][7][8] locking plates, [9][10][11][12] and retrograde intramedullary nails. [13][14][15] It is of interest that cadaveric studies have consistently showed that regardless of fracture pattern, retrograde intramedullary fixation with distal locking screws has demonstrated the highest resistance to fatigue, failure and resistance to both axial and torsional forces when compared to fixed angle devices.…”

Section: Introductionmentioning

confidence: 99%

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

Atrey

Hussain²,

Gosling³

et al. 2017

Journal of Orthopaedics

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Introduction: Although the use of an endoprosthesis for distal femoral fractures remains a valid treatment option the widespread use is in its infancy. Methodology: In this retrospective case series, we review cases of distal femoral fracture treated with endoprosthetic replacement (EPR). The outcomes we assessed were the time to start mobilising, the time to discharge, morbidity and mortality as well as an Oxford knee score to assess pain and function and also the early survivorship. 6 of the 11 from the cohort had existing Total Knee Replacements (TKRs) in situ. Results: There were 11 knees in our cohort with a mean age of 81.5 years (range 52-102 years). The median time to follow up was 3.5 years (range 1.6 to 5.5 years). The median times to theatre was 3 days and to discharge was 16 days. Oxford functional and pain scores were 32/48. Discussion: In the appropriate patient and fracture pattern, Endoprosthetic knee replacement is an excellent option in the treatment of distal femoral fractures whether associated with an existing TKR or not. The implant is more costly than traditional open reduction and internal fixation, but the earlier return to full mobility post-operatively may save on hospital/care home stay and free up hospital space and minimise complications.

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“…введение повреждения бедренной кости составля-ют 15-45% в общей структуре переломов [1]. Однако переломы дистального отдела бедрен-ной кости встречаются относительно редко -их частота варьирует от 0,4 до 7% от всех пе-реломов бедренной кости [2][3][4][5][6]. по данным B.D.…”

Section: Discussionunclassified

“…Crist с соавторами, у европейцев переломы этой локализации встречаются в 10 раз реже, чем переломы проксимального отдела бедрен-ной кости [7]. при этом в 84% случаев возраст больных с переломами дистального отдела бе-дренной кости превышает 50 лет [2]. причинами такой травмы у людей молодого и среднего воз-раста чаще всего являются дорожно-транспорт-ные происшествия, в то время как у людей по-жилого возраста (преимущественно женщин) данные переломы происходят и при низко-энергетической травме, например, при падении с высоты собственного роста [8,9].…”

Section: Discussionunclassified

Experimental and Theoretical Validation of Double Column Internal Fixation Theory for Distal Femoral Fractures

Беленький¹,

Sergeev²,

Майоров³

et al. 2017

Traumatology and Orthopedics of Russia

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Purpose of the study – to experimentally compare efficiency of lateral and bilateral (lateral and medial) plate fixation of distal femoral fractures and to validate the appropriateness of double column theory of distal femur anatomy for internal fixation for these fractures.Material and methods. The authors performed a biomechanical study in two series on polyurethane models of right femur corresponding in dimensions to natural femur. After simulating a 33 C2 fracture type it was fixed by one lateral plate or two (lateral and medial) plates. After fixation the models were tested in six load ranges with maximal load from 20 to 120 kgf in cyclic mode.Results. The authors obtained a significant difference in absolute values of fragments displacement amplitude depending on fixation method. In the first series of the experiment – one plate fixed on the lateral surface of the femur – under minimal load the displacement value was reported as0.3 mm and under maximal load —1.9 mm; in the second series of experiment – two plates fixed on the lateral and medial surfaces of the femur – displacement values were reported as0.35 mm and0.95 mm respectively. Conclusion. The presence or absence of medial support after internal fixation has a profound impact on ensuring stability in cases of comminuted fractures of distal femoral fractures. In this context the use of double column theory of distal femur anatomy for internal fixation can significantly improve the treatment outcomes for such patients. After trials of minimally invasive fixation method on anatomical specimen the described theory can be implemented into the clinical practice.

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Epidemiology and Treatment of Distal Femoral Fractures in Adults

Cited by 115 publications

References 11 publications

Management of distal femur fractures with locking compression plate: a prospective study

Management of distal femur fractures with locking compression plate: a prospective study

A 3 year minimum follow up of Endoprosthetic replacement for distal femoral fractures — An alternative treatment option

Experimental and Theoretical Validation of Double Column Internal Fixation Theory for Distal Femoral Fractures

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