Evaluation of Results of Open Reduction and Internal Fixation (ORIF) of Fracture of Distal End of Femur with Intra-Articular Extension

Abstract

Introduction: Fractures of the distal femur account for 0.4% of all fractures. They involve about 7% of all femur fractures, with bimodal age distribution, commonly occur during high-velocity trauma of motor vehicle accidents in the younger group of patients and are frequently associated with other skeletal injuries. The treatment of distal femoral fractures has evolved from conservative treatment to more aggressive operative treatment. The aim is to achieve and maintain a good reduction of the joint to allow early active mobilisation, thus minimising the joint stiffness and severe muscular atrophy encountered in the conservative treatment. Materials and methods: This is a retrospective study of 25 patients with distal femur fracture with intra-articular extension treated with open reduction and internal fixation with DFLP, admitted at our institute between 2016 to 2019, with a minimum follow-up of six months. Results: In our study, 19 (76%) patients had excellent to good results. Three (12%) patients had fair outcomes, and three (12%) patients had poor outcomes according to Neer’s score. The average time for bone union in closed fractures was earlier (4.25 months) than open fractures, averaging 5.86 months. The outcome was almost similar between closed and open fractures. There were 2 (8%) cases of infection in the early post-operative period, 7 (12%) patients suffered from knee stiffness, and there were 3 (12%) cases with a pre-operative bone loss that required bone grafting. Conclusion: Management of complex intra-articular distal femur fracture has always been a challenge. Anatomical reduction of articular fragments and rigid fixation of these fractures are a must. DFLP provides angular stability with multiple options to secure fixation of both metaphyseal and articular fragments with the restoration of the joint congruity, limb length, alignment and rotation, allowing early mobilisation and aggressive physiotherapy without loss of fixation, resulting in gratifying functional outcome and low complication rate.

Evaluation of Walking Disorders After Lower Extremity Fractures

“…As a surgical application, open reduction internal fixation (ORIF) method is seen as the most reliable method to provide articular surface restoration in terms of coronal, axial and sagittal plane alignment. (4) However, conservative treatment can also be used in some lower extremity fractures such as the calcaneus, considering complications such as infection after surgical treatment or the need for a second operation to remove the screws and plates that cause pain. (9) After lower extremity fractures, kinesiophobia may develop by deteriorating gait and balance parameters in the patient.…”

“…The most common lower extremity fractures, which usually occur during high-speed traumas, are fractures of the femur, which is one of the longest and strongest bones in the body and is one of the bones that carry the load of the lower extremity. (3,4) Approximately 7% of all femur fractures are distal femur fractures. (4) Another lower extremity fracture is tibial fractures.…”

“…(3,4) Approximately 7% of all femur fractures are distal femur fractures. (4) Another lower extremity fracture is tibial fractures. Tibial fractures mainly affect young adults.…”