Retrograde locking nail fixation of distal femoral fractures with the distal femur nail (DFN)

2002 ◽  
Vol 16 (10) ◽  
pp. 747 ◽  
Author(s):  
&NA;
Keyword(s):  
Distal Femur ◽  
Femoral Fractures ◽  
Distal Femoral Fractures ◽  
Locking Nail ◽  
Distal Femur Nail

“FUNCTIONAL OUTCOME OF RETROGRADE NAILING IN THE MANAGEMENT OF SUPRACONDYLAR AND DISTAL FEMORAL FRACTURE”

2021 ◽  
pp. 107-109
Author(s):  
Avinash Kumar Choudhary ◽  
M.K Aseri ◽  
Sumit Machra ◽  
Devendra Singh
Keyword(s):  
Femoral Fracture ◽  
Distal Femur ◽  
Femoral Fractures ◽  
High Energy ◽  
Valgus Deformity ◽  
Minor Trauma ◽  
Rating Score ◽  
Joint Congruency ◽  
Distal Femoral Fractures

INTRODUCTION: Fractures of the Distal femur are complex injuries that pose a challenge to the orthopaedic surgeon. It constitutes about 6 % of all femoral fractures. It usually occurs during high energy trauma in younger patients and frequently are associated with concomitant injuries. In contrast, elderly patients with severe osteopenia might sustain solitary distal femoral fractures from minor trauma such as a simple fall. Proper diagnosis and treatment leads to early mobilization and rehabilitation of patients. MATERIAL AND METHODS :This prospective study was conducted in Department of Orthopedics at Dr. S. N. Medical College and Associated group of Hospital, Jodhpur ,Rajasthan ,India on 30 patients who underwent the surgery with retrograde intramedullary interlocking nail in the management of extra-articular supracondylar femoral fracture from August 2019 to November 2020. On follow up axial alignment was assessed and functional analysis was quantied using NEERS RATING SYSTEM, Radiographs was analyzed for correction, maintenance of position or loss of reduction. function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients. RESULTS: In our study 30 patients with supracondylar & distal femoral fractures based on AO Classication on MULLER ET AL underwent retrograde supracondylar nail, long term nal result were rated using NEER'S RATING SCORE , which gives point for pain, function, working, joint movement ,gross and radiological appearance. NEER'S RATING SCORE assigned for each patient after 24 weeks of follow up. After accessing this score out of total 30 patients, 10 have excellent score, 10 have good score, 8 have fair score and next 2 have poor score. Function around knee was accessed according to Schatzker and Lambert Criteria, measures the exion/extension , varus/valgus deformity , joint congruency and pain in operated patients,out of 30 patients 9 patients have an excellent result , 8 have good ,12 have fair and only 1 patient have poor result CONCLUSION:The retrograde intramedullary locked nail provides the surgeon with a different option in treatment of specic supracondylar fracture patterns. It offers a practical advantages of simple and efcient technique for patients with polytrauma, oating knee injuries and in elderly. this technique is very useful in distal femur fracture where antegrade nailing does not provide stability and also where plate xation is not suitable due to soft tissue condition.

scholarly journals The use of ‘blocking’ screws for the ‘closed’ reduction of difficult proximal and distal femoral fractures

2021 ◽  
Vol 6 (6) ◽  
pp. 451-458
Author(s):  
Christos Garnavos
Keyword(s):  
Distal Femur ◽  
Operative Procedure ◽  
Femoral Fractures ◽  
Fracture Site ◽  
Skeletal Traction ◽  
Minimal Invasiveness ◽  
Distal Femoral Fractures ◽  
Tissue Integrity ◽  
Wound Healing Problems ◽  
Metaphyseal Fractures

Most meta-diaphyseal femoral fractures that are treated with intramedullary nailing can be reduced satisfactorily by skeletal traction without ‘opening’ the fracture site and therefore, complications such as nonunion, infection and wound healing problems are reduced. In cases where adequate fracture reduction cannot be achieved by skeletal traction, ‘reduction aids’ have been used during the operative procedure in order to avoid the exposure of the fracture site. The ‘blocking’ screw, as a reduction tool, was proposed initially for the ‘difficult’ metaphyseal fractures of the tibia. Subsequently, surgeons have tried to implement the ‘blocking’ screw technique in ‘difficult’ distal femoral fractures. This article presents the ‘blocking’ screw technique as an adjunctive process in the management of fractures of the proximal and distal femur which are found to be non-reducible by skeletal traction alone. The minimal invasiveness of the technique contributes greatly to the preservation of both the soft tissue integrity and the fracture haematoma and thus reduces the major complications that can occur by exposing the fracture site. Cite this article: EFORT Open Rev 2021;6:451-458. DOI: 10.1302/2058-5241.6.210024

scholarly journals Clinical outcomes of treatment with locking compression plates for distal femoral fractures in a retrospective cohort

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Masahiro Kiyono ◽  
Tomoyuki Noda ◽  
Hiroshi Nagano ◽  
Takashi Maehara ◽  
Yasuaki Yamakawa ◽  
...  
Keyword(s):  
Bone Fracture ◽  
Distal Femur ◽  
Femoral Fractures ◽  
Bone Union ◽  
Span Length ◽  
Union Rate ◽  
Non Union ◽  
Distal Femoral Fractures ◽  
Bridge Span ◽  
Comminuted Fractures

Abstract Background Plate fixation is one of the standard surgical treatments for distal femoral fractures. There are few reports on the relationship between the screw position and bone union when fixing by the bridging plate (relative stability) method. Methods This retrospective study included 71 distal femoral fractures of 70 patients who were treated with the locking compression plate for distal femur (DePuy Synthes Co., Ltd, New Brunswick, CA, USA). The following measurements were evaluated and analyzed: (1) bone union rate, (2) bridge span length (distance between screws across the fracture), (3) plate span ratio (plate length/bone fracture length), (4) number of empty holes (number of screw holes not inserted around the fracture), and (5) medial fracture distance (bone fracture distance on the medial side of the distal femur). Patient demographics (age), comorbidities (smoking, diabetes, chronic steroid use, dialysis), and injury characteristics (AO type, open fracture, infection) were obtained for all participants. Univariate analysis was performed on them. Results Of 71 fractures, 26 fractures were simple fractures, 45 fractures were comminuted fractures, and 7 fractures resulted in non-union. Non-union rate was significantly higher in comminuted fractures with bone medial fracture distance exceeding 5 mm. Non-union was founded in simple fractures with bone medial fracture distance exceeding 2 mm, but not significant (p = 0.06). In cases with simple fractures, one non-union case had one empty hole and one non-union case had four empty holes, whereas in cases with comminuted fractures, five non-union cases had two more empty holes. Conclusions We concluded that bone fragment distance between fracture fragments is more important than bridge span length of the fracture site and the number of empty holes. Smoking and medial fracture distance are prognostic risk factors of nonunion in distal femoral fractures treated with LCP as bridging plate.

The effects of dual plating on the vascularity of the distal femur

2020 ◽  
Vol 102-B (4) ◽  
pp. 530-538 ◽  
Author(s):  
Natalie C. Rollick ◽  
Naomi E. Gadinsky ◽  
Craig E. Klinger ◽  
Jeremy F. Kubik ◽  
Jonathan P. Dyke ◽  
...  
Keyword(s):  
Distal Femur ◽  
Femoral Fractures ◽  
Barium Sulphate ◽  
Quantitative Mri ◽  
Post Contrast ◽  
Distal Femoral Fractures ◽  
Significant Difference ◽  
Dual Plating ◽  
Lateral Plating ◽  
Single Versus

Aims Dual plating of distal femoral fractures with medial and lateral implants has been performed to improve construct mechanics and alignment, in cases where isolated lateral plating would be insufficient. This may potentially compromise vascularity, paradoxically impairing healing. This study investigates effects of single versus dual plating on distal femoral vascularity. Methods A total of eight cadaveric lower limb pairs were arbitrarily assigned to either 1) isolated lateral plating, or 2) lateral and medial plating of the distal femur, with four specimens per group. Contralateral limbs served as matched controls. Pre- and post-contrast MRI was performed to quantify signal intensity enhancement in the distal femur. Further evaluation of intraosseous vascularity was done with barium sulphate infusion with CT scan imaging. Specimens were then injected with latex medium and dissection was completed to assess extraosseous vasculature. Results Quantitative MRI revealed a mean reduction of 21.2% (SD 1.3%) of arterial contribution in the lateral plating group and 25.4% (SD 3.2%) in the dual plating group (p = 0.051); representing a mean decrease in arterial contribution of 4.2%. The only significant difference found between both experimental groups was regionally, at the lateral aspect of the distal femur with a mean drop in arterial contribution in the lateral plating group of 18.9% (SD 2.6%) versus 24.0% (SD 3.2%) in the dual plating group (p = 0.048), representing a mean decrease in arterial contribution of 5.1%. Gross dissection revealed complete destruction of periosteal vessels underneath either medial or lateral plates in both groups. The network of genicular branches contributing to the posterior and distal femoral condyles was preserved in all specimens. A medial vascular pedicle was found dividing from the superficial femoral artery at a mean 12.7 cm (SD 1.7) proximal to the medial epicondyle and was undisrupted in the dual plating group. Conclusion Lateral locking-plate application resulted in mean 21.2% reduction in distal femur vascularity. Addition of medial plates did not further markedly decrease vascularity. As such, the majority of the vascular insult occurred with lateral plating alone. Supplemental medially based fixation did not lead to marked devascularization of the distal femur, and should therefore be considered in the setting of comminution and poor bone stock in distal femoral fractures. Further clinical research is required to confirm the results of this study. Cite this article: Bone Joint J 2020;102-B(4):530–538.

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

2018 ◽  
Vol 4 (2) ◽  
pp. 208
Author(s):  
Sridhar Reddy Konuganti ◽  
Sreenath Rao Jakinapally ◽  
Vennamaneni Pratish Rao ◽  
Sivaprasad Rapur
Keyword(s):  
Prospective Study ◽  
Distal Femur ◽  
Femoral Fractures ◽  
Locking Compression Plate ◽  
Functional Score ◽  
Non Union ◽  
Distal Femoral Fractures ◽  
Femur Fractures ◽  
Compression Plate ◽  
The Mean

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">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.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">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</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">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). </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">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.</span></p><p class="Default"> </p>

scholarly journals “A Modified Anterolateral Swashbuckler Approach for Distal Femoral Fractures: Description and Outcomes”

2021 ◽  
Author(s):  
Stefano Ghirardelli ◽  
GEORGIOS TOULOUPAKIS ◽  
EMMANOUIL THEODORAKIS ◽  
Guido Antonini ◽  
Bruno Violante ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Distal Femur ◽  
Weight Bearing ◽  
Femoral Fractures ◽  
Extensor Mechanism ◽  
Consecutive Series ◽  
Functional Evaluation ◽  
Lateral Plate ◽  
Medial Condyle ◽  
Distal Femoral Fractures

Abstract Background: The treatment of distal femur fractures represents a challenging task. General and local factors, including bone quality, articular surface involvement, fracture comminution, associated soft tissue injuries and ultimately fixation system, all play a role in the final clinical outcome. Current surgical approaches often undermine patellar vascularization and integrity of the extensor apparatus, not guaranteeing sufficient visualization of the medial condyle. This technical note presents the efficacy and safety a new surgical technique to address distal femoral fractures. Methods: The original "swashbuckler" surgical approach was modified in order to obtain a better visualization of the lateral and medial femoral condyles without affecting the knee extensor mechanism and the anastomotic arterial supply of the patella. This modified surgical approach was utilized in a consecutive series of patients presenting with a Müller AO 33 distal femur or periprosthetic fracture of the knee. The final outcome was recorded according to a functional evaluation scoring system.Results: Twelve patients (2 males and 10 females) with a mean age of 67,8 years (min. 18; max 90 years) were included in this series. The same, modified "swashbuckler" surgical approach was applied in all cases. Multiple internal fixation techniques, including a single lateral plate, a combination of a lateral and medial plate, a single lateral plate associated with lag screws, were used to obtain a satisfactory stabilization of the fracture site. All patients were reviewed at a minimum one-year follow up (median 15 months): all patients regained their level of activities of daily living. No major intraoperative or postoperative complications were recorded. Conclusions: The modified swashbuckler approach allows anatomical reduction and appropriate fixation with minimal severance of the blood supply to the patella and ensures rapid weight bearing resumption thanks to an intact extensor mechanism.

scholarly journals Minimally invasive plate osteosynthesis with dual plating for periprosthetic distal femoral fractures following total knee arthroplasty

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yong-Geun Park ◽  
Hyunseong Kang ◽  
Jung-Kook Song ◽  
Jaehwang Lee ◽  
Joseph Y. Rho ◽  
...  
Keyword(s):  
Distal Femur ◽  
Callus Formation ◽  
Plate Osteosynthesis ◽  
Femoral Fractures ◽  
Minimally Invasive Plate Osteosynthesis ◽  
Distal Femoral Fractures ◽  
Femur Fractures ◽  
Dual Plating ◽  
Total Knee

Abstract Introduction Adequate treatment for periprosthetic distal femur fractures is challenging because of various reasons, including severe osteoporosis and distal fragments that are too small or too distal. We have introduced a new surgical technique for dual plating of periprosthetic distal femur fractures following total knee arthroplasty (TKA) and determined the clinical and radiological outcomes of minimally invasive plate osteosynthesis (MIPO) with a dual locking compression plate (LCP). Materials and methods Between January 2010 and July 2019, 18 patients [mean age, 74.8 (68–89) years; average follow-up period, 14.8 (12–43) months] underwent MIPO with distal femoral LCP laterally and proximal humeral internal locking system (PHILOS) medially for periprosthetic distal femoral fractures following TKA. The minimum follow-up was 1 year. The clinical and radiological outcomes were assessed using the modified WOMAC scores, knee range of motion, time to callus formation, time to union, and complications of malunion, nonunion, and shortening. Results The average time to union was 18.4 weeks (range, 10–51 weeks) and to callus formation was 7.8 weeks (range, 2–14 weeks). At the 1-year follow-up, the average JLETS was 37.6 (range, 24–53), average knee ROM was 110.3° (range, 80–135°), and average varus-valgus angles of the distal femur were 3.2° (range, −2.9–10.5°). No nonunion, broken plates, or implant failure occurred. Malunion occurred in three patients. Conclusion MIPO with dual LCP is a reliable method for stabilizing periprosthetic distal femoral fractures following TKA, with satisfactory bone union rates and low complication rates.

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