To Assess Functional Outcome for Intra-Articular and Extra-Articular Distal Femur Fracture in Patients using Retrograde Nailing or Locked Compression Plating

Agarwal, Saumya; Udapudi, Shailesh V.; Gupta, Srinath

doi:10.7860/jcdr/2018/32217.11325

Cited by 3 publications

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“…Several studies combine all extraarticular distal femur fractures together when evaluating outcomes with regard to the fixation method [16][17][18]. However, depending on the specific extraarticular fracture pattern, one method of fixation may not always be superior.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Distal Third Femur Fractures in Patients 18 Years and Older: A Pilot Study

Roytman,

Jabbouri,

O'Marr

et al. 2024

Cureus

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Introduction:The selection of the most optimal fixation method for fractures of the distal femur, whether intramedullary nail (NL), lateral locking plate (PL), or nail/plate (NP) is not always clear. This study retrospectively evaluates surgical patients with distal femur fractures and introduces a pilot study using cluster analysis to identify the most optimal fracture fixation method for a given fracture type.Methods: This is a retrospective cohort study of patients 18 years and older with an isolated distal femur fracture who presented to our Level-1 trauma center between January 1, 2012, and December 31, 2022, and obtained NL, PL, or NP implants. Patients with polytrauma and those without at least six months of followup were excluded. A chart review was used to obtain demographics, fracture classification, fixation method, and postoperative complications. A cluster analysis was performed. The following factors were used to determine a successful outcome: ambulatory status pre-injury and 6-12 months postoperatively, infection, non-union, mortality, and implant failure.Results: A total of 169 patients met inclusion criteria. No statistically significant association between the fracture classification and fixation type with overall outcome was found. However, patients treated with an NP (n = 14) had a success rate of 92.9% vs only a 68.1% success rate in those treated with a PL (n = 116) (p = 0.106). The most notable findings in the cluster analysis (15 total clusters) included transverse extraarticular fractures demonstrating 100% success if treated with NP (n = 6), 50% success with NL (n=2), and 78.57% success with PL fixation (n=14). NP constructs in complete articular fractures demonstrated success in 100% of patients (n = 5), whereas 77.78% of patients treated with NL (n = 9) and 61.36% of those treated with PL (n = 44).Conclusions: Plate fixation was the predominant fixation method used for distal third femur fractures regardless of fracture classification. However, NP constructs trended towards improved success rates, especially in complete intraarticular and transverse extraarticular fractures, suggesting the potential benefit of additional fixation with these fractures. Cluster analysis provided a heuristic way of creating patient profiles in patients with distal third femur fractures. However, a larger cohort study is needed to corroborate these findings to ultimately develop a clinical decision-making tool that also accounts for patient specific characteristics.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Distal Third Femur Fractures in Patients 18 Years and Older: A Pilot Study

Roytman,

Jabbouri,

O'Marr

et al. 2024

Cureus

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Bone reconstruction with modified Masquelet technique in open distal femoral fractures: a case series

Kalantar,

Saffar,

Hoveidaei

2024

BMC Musculoskelet Disord

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Background Large bone defects require complex treatment, multidisciplinary resources, and expert input, with surgical procedures ranging from reconstruction and salvage to amputation. The aim of this study was to provide the results of a case series of open comminuted intra-articular distal femoral fractures with significant bone loss that were managed by early fixation using anatomical plates and a modified Masquelet technique with the addition of surgical propylene mesh. Methods This retrospective study included all patients referred to our institution with OTA/AO C3 distal femur open fractures and meta-diaphyseal large bone loss between April 2019 and February 2021. We treated the fractures with irrigation and debridement, acute primary screw and plate fixation in the second look operation, and Masquelet method using shell-shaped antibiotic beads supplemented by propylene surgical mesh to keep the cements in place. The second step of the procedure was conducted six to eight weeks later with bone grafting and mesh augmentation to contain bone grafts. Surprisingly, hard callus formation was observed in all patients at the time of the second stage of Masquelet procedure. Results All five patients’ articular and meta-diaphyseal fractures with bone loss healed without major complications. The average union time was 159 days. The mean knee range of motion was 5–95 degrees. The average Lower Extremity Functional Score (LEFS) was 49 out of 80. Conclusions Combination of early plate fixation and the modified Masquelet technique with polypropylene mesh is an effective method for managing large bone defects in open intra-articular distal femoral fractures with bone loss, resulting in shorter union time possibly associated with the callus formation process. This technique may also be applicable to the management of other similar fractures specially in low-income and developing areas.

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Comparing Outcomes of Retrograde Intramedullary Nail and Locking Plate Fixation in Distal Femoral Fractures

Yoon

Hwang

et al. 2021

J Korean Fract Soc

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To Assess Functional Outcome for Intra-Articular and Extra-Articular Distal Femur Fracture in Patients using Retrograde Nailing or Locked Compression Plating

Cited by 3 publications

References 0 publications

Outcomes of Distal Third Femur Fractures in Patients 18 Years and Older: A Pilot Study

Outcomes of Distal Third Femur Fractures in Patients 18 Years and Older: A Pilot Study

Bone reconstruction with modified Masquelet technique in open distal femoral fractures: a case series

Comparing Outcomes of Retrograde Intramedullary Nail and Locking Plate Fixation in Distal Femoral Fractures

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