Locking condylar plate: best device to treat supracondylar fractures of the femur

Background: Supracondylar fractures of the femur in adults account for only 7% of all femoral fractures. However, these fractures present with numerous complications. The purpose of this study was to assess the outcome of locking condylar plate in supracondylar fractures of femur in adults.Methods: This study was based on 25 patients of supracondylar fracture of the femur treated with locking condylar plate at Srinivas Institute of Medical Sciences and Research Centre, Mukka, Suratkal, Mangalore. The patients were followed up for 1 year.Results: In present study, 84% fractures were sustained due to road traffic accidents. In 23 (92%) patients, full weight bearing was achieved at 20 weeks while only 2 (8%) patients required more than 20 weeks. 80% of cases required less than 16 weeks for union while 20% required more than 16 weeks. Average injury to surgery time was 3.62 days in the present series. Superficial stitch infection occurred in two cases. Deep infection occurred in a grade 2 compound fracture in a male who was treated initially with debridement and antibiotics.Conclusions: Good results are seen by distal femur locking condylar plate alone. It is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation. Advantage of the mechanical properties of a locking plate is definitely useful.

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Functional outcome of fixation of distal femoral fractures with DF-LCP: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164000 ◽

2016 ◽

Vol 2 (4) ◽

pp. 291 ◽

Cited By ~ 1

Author(s):

Shafeed T. P. ◽

Bijo Paul

Keyword(s):

Tissue Injury ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Femoral Fractures ◽

Early Mobilization ◽

Type A ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Range Of Movement ◽

Locked Plating

Background: Management of supracondylar fractures is a real challenge to the orthopaedician due to its extensive soft tissue injury, boneloss, comminution, articular extention and instability. Open reduction and internal fixation with anatomical distal femoral locking plate permits early mobilization. Stable anatomical fixation is necessary to avoid complications and disability.Methods: 25 patients with Type A and Type C closed supracondylar femoral fractures were followed up from November 2013 to November 2015. All the patients underwent ORIF with DF-LCP. Clinical and radiological follow up were recorded for 24 months.Results: Mean time for fracture union was 4.02 months. Average duration for full weight bearing was 122 days (range 90-180days). The average range of movement for Type A fractures was 105.71 degrees, for C fractures average ROM was 93.64 degrees. Average ROM for patients <50 was 103 degree and for patients>50 ROM was 98.66 degree. Conclusions: Locked plating of DF fractures permits stable fixation and early mobilization which avoids disability and ensures good joint function.

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A study on clinical outcomes of complex subtrochanteric femoral fractures with cephalomedullary nail

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20214188 ◽

2021 ◽

Vol 7 (6) ◽

pp. 1194

Author(s):

S. F. Kammar ◽

Karthik B. ◽

V. K. Bhasme ◽

Suryakanth Kalluraya

Keyword(s):

Clinical Outcomes ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Lateral View ◽

Successful Outcome ◽

Harris Hip Score ◽

Full Weight Bearing ◽

Subtrochanteric Fractures ◽

The Mean

Background: The aim of the study was to evaluate the clinical outcomes of complex subtrochanteric fractures treated by using cephalomedulary nail.Methods: This is a prospective observational study of 30 cases of complex subtrochanteric femoral fractures admitted to our hospital from January 2018 to June 2019. Cases were taken according to the inclusion and exclusion criteria i.e. type IV, type V Seinsheimer’s classification, above 18 years and those who are willing to participate in the study has been included and pathological fractures, open fractures were excluded. All the patients are followed up on 2 post-operative day, after 4 weeks, 8 weeks, 12 weeks and 6months. X-ray hip with thigh anteroposterior (AP) and lateral view taken during each follow up. Out comes was assessed using modified Harris hip score.Results: In our study of 30 cases there are 22 males and 8 females and the mean age of 43.7 years. 73.3% patients are due to Road traffic accidents predominance of right side. In our study 66% had type 4 Seinsheimers and 34% cases had type 5 Seinsheimers fracture. The mean duration of hospital stay was 17 days. Mean time for full weight bearing is 12 weeks. Good to excellent results are seen in 80% of type 4 subtrochanteric fractures and 75% of cases of type 5 subtrochanteric fractures. 4 cases had surgical site infection, 3 cases had varus, 1 case had developed implant failure, and 1 case had reverse Z effect.Conclusions: From this study, we conclude that proximal femoral nail is an excellent implant in the treatment of complex subtrochanteric femoral fractures the terms of successful outcome include a good understanding of fracture biomechanics, good preoperative planning and accurate instrumentation.

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RETROGRADE INTRAMEDULLARY SUPRACONDYLAR NAILING AND DISTAL FEMORAL LOCKING COMPRESSION PLATE IN THE MANAGEMENT OF DISTAL FEMUR FRACTURES – A COMPARATIVE STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2022.v15i1.43463 ◽

2021 ◽

pp. 97-99

Author(s):

NARSIMHULU SY ◽

HARI KUMAR S

Keyword(s):

Blood Loss ◽

Distal Femur ◽

Road Traffic ◽

Damage Control ◽

Plate Fixation ◽

Locking Compression Plate ◽

Supracondylar Fractures ◽

Fracture Union ◽

Femur Fractures ◽

Compression Plate

Objectives: The objective of the study is to assess the efficacy of retrograde intramedullary interlocking supracondylar nailing and distal femoral locking compression plate in the management of distal femur fractures. Methods: The present prospective study consists of a total of 36 cases with extra-articular supracondylar fractures of the femur between the age group of 21–70 years. Participants were randomly allocated to group 1 treated with distal femoral locking compression plate fixation and group 2 treated with retrograde intramedullary interlocking supracondylar nailing technique. Post-operatively, all the cases were followed up in regular intervals to assess the functional outcome using the American Knee Society score. Results: Road traffic accidents (80.56%) were the most common cause of injury. The average surgical duration (108 min and 90.14 min), duration of fracture union (12.48 weeks and 11.08 weeks), and blood loss (339.8 ml and 236.6 ml) was better in the nailing group than the plating group, respectively. The overall outcome was comparable between the two study groups. Conclusion: The supracondylar nailing technique has better functional outcomes in terms of less fracture union time, less operative duration, and minimal operative blood loss. Supracondylar nailing technique was effective and better in soft tissue damage control.

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DIAPHYSEAL FEMORAL FRACTURES

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.04.1332 ◽

2015 ◽

Vol 22 (04) ◽

pp. 476-482

Author(s):

Muhammad Azeem Akhund ◽

Karam Ali Shah ◽

Allah Nawaz Abbasi ◽

Zulfiqar Ali Mastoi

Keyword(s):

Road Traffic ◽

Callus Formation ◽

Weight Bearing ◽

Femoral Fractures ◽

P Value ◽

Female Ratio ◽

Femur Fractures ◽

Group A ◽

The Mean ◽

Group B

The femur fractures usually happen with oomph forces like motor vehicleaccidents. Objectives: To assess the mode of injury and complications of the management, indiaphyseal femoral fractures, in comparison of close versus open intramedullary interlockingnail (IMN). Study Design: Experimental and comparative study. Period: April 2013 to March2014. Setting: Department of Orthopaedic Surgery, Peoples University of Medical & Healthsciences, Nawabshah. Methods: The cases were divided into two groups A and B. Group Awas treated by open nailing (n = 20) and group B by close nailing (n = 20), all the cases wereoperated within 48 hours of admission. All the data were recorded on well structured proforma.Serial radiographies were performed at 3, 6, 12 weeks, and 6 months; additional radiographieswere performed as needed postoperatively. Knee, ankle, and hip motions were begun andprotected weight bearing was started on the second day postoperatively and increasedgradually to full WB depending on x-ray findings of callus formation. The patients were followedfor two years. Results of open and closed I.M.N were assessed and the complications if anywere observed over a mean follow-up period of two years. Results: The mean age in groupA was 29.40 years and the mean age in group B was 30.45 years. Out of 40 cases, 32(80.0%)were males with male to female ratio 1:4. Mean ± SD hospital stay was 19.80 ± 14.60 days ingroup A, and 17.90 ± 5.95 days in group B (p value 0.55). Average time between injury andadmission was 1.53 days (n = 40), in the group A it was 1.05 days, and in the group B it was2.0 days (p value 0.03). The average of time between injury and operation in the group A was8.75 days, and in the group B, it was 8.20 days, (p value 0.71). The average of time betweenadmission and discharge in the group A was 11.0 days, and in the group B was 9.15 days,(p value 0.55). Mean ± SD union time was 11.70 ± 6.45 weeks, in group A and 11.90 ± 5.77weeks, in group B. (p value 0.91). All the patients had full ranged of hip motion and 2 (10.0%)patients of group A had mild limitation of knee motion with a flexion ranges between 80 and110 degrees. Final functional results based on Thoresen BO criteria16. Excellent results wereobserved in 19 (47.5%) cases, out of them 5(25.0%) were in group A and 14(70.0%) were ingroup B. Good results were found in 13(32.5%) patients, out of these 7(35.0%) were in group Aand 6(30.0%) were in group. Fair and poor results were detected in 4(10.0%) cases of group A.Conclusions: Road traffic accidents by motorcycle was found the commonest (47.5%) causeof femur fracture, a few complications were observed in open interlocking nailing as comparedto closed interlocking nails.

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Management of Complex Distal Femur Fractures: Comparative Study between Ilizarov External Fixation and Double Plating

QJM ◽

10.1093/qjmed/hcaa059.007 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M F Thakeb ◽

A H Gooda ◽

T A Fayyad ◽

M A Elkersh ◽

E N Abourisha

Keyword(s):

Knee Society Score ◽

Distal Femur ◽

Weight Bearing ◽

Femoral Fractures ◽

Controlled Study ◽

Level Of Evidence ◽

Femur Fractures ◽

Randomized Clinical Study ◽

Significant Difference ◽

Double Plating

Abstract Background In this prospective randomized clinical study, we report results of management of type C2 and C3 distal femur fractures by Ilizarov external fixator in comparison with double plating through separate medial and lateral approaches with a mean of 42.8 ± 6.84 weeks follow-up. Patients and Methods In this study we managed 30 cases with highly comminuted distal femoral fractures AO classification type C2 or C3. Fifteen cases were surgically managed by Ilizarov technique and the other fifteen cases were surgically managed by double plating technique. We compare between both group as regard clinical, radiological results and rate of complications. Results while using Knee society score, the results are the following: In Ilizarov group: 7 cases (46.67%) are excellent, 4 cases (26.67%) are good, 3 cases (20.00%) had fair results while 1 case (6.67%) had poor results. In internal fixation group, 8 cases (53.33%) had excellent results, 3cases (20%) had good results, 2 cases (13.33%) had fair results while 2 cases (13.33%) had poor results. Conclusion In fixation of complex distal femur fracture, both Ilizarov and double plating methods had no significant difference in clinical outcome by knee society score and in rate of complications. Ilizarov allow earlier weight bearing and less blood loss while double plating gives better ROM of knee joint and rapid radiological healing. Level of Evidence Level I Randomized controlled study.

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Radiologic and functional outcome in patients with ipsilateral fractures of proximal femur and shaft treated by long proximal femoral nailing

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20205574 ◽

2020 ◽

Vol 7 (1) ◽

pp. 129

Author(s):

Saju S. ◽

Thomas M. A.

Keyword(s):

Functional Outcome ◽

Proximal Femur ◽

Weight Bearing ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Femoral Nailing ◽

Femur Fractures ◽

The Mean ◽

Mean Time ◽

Proximal Femoral Nailing

Background: Combination of ipsilateral proximal femur and shaft of femur fractures are one of the rare fractures which were previously managed with two different implants for each fracture. Various studies have shown that long proximal femoral nailing is as effective as two different implants in fracture healing.Methods: 25 cases in the age group of 20-80 years with ipsilateral proximal femur and shaft of femur fractures were enrolled from July 2014 to July 2017 and treated with long proximal femoral nailing. The cases were followed up at 6 weekly intervals and were assessed for their functional outcome using Friedman and Wyman criteria.Results: Proximal femoral fractures united at an average time of 3.96 ±1.3 months, whereas the mean time shaft of femur fractures took to unite was 5.67±3 months. The mean time patients took to start full weight bearing was 6.15±2.76 months. Functional assessment at 12 months revealed outcome as good in18 (75%), fair in 5 (20.8%) and poor in 1 (4.1%).Conclusions: Long proximal femoral nailing is a good option in managing patients with ipsilateral proximal and shaft of femur fractures.

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Internal fixation of pediatric shaft femur fractures by titanium elastic nails: clinical and radiological study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164157 ◽

2016 ◽

Vol 2 (4) ◽

pp. 299

Author(s):

Manoharan M. ◽

Mahapatra S.

Keyword(s):

Weight Bearing ◽

Joint Stiffness ◽

Femoral Fractures ◽

Full Weight Bearing ◽

Age Group ◽

Femur Fractures ◽

Pediatric Age Group ◽

Elastic Nails ◽

Elastic Nail ◽

Operative Fixation

Background: Management of diaphyseal femoral fractures in the pediatric age group is challenging. There has been a demand worldwide for operative fixation.Methods: Twelve children (7 boys, five girls) aged 6-16 years with diaphyseal femoral fractures (12 fractures, one in each) was stabilized with titanium elastic nail system (TENS). Patients underwent surgery within a week days of their injury. The results were evaluated using Flynn's Scoring system. Identical two nails were used in each fracture.Results: All 12 patients were available for evaluation and follow-up for a mean duration of 24 months (14-34 months). Radiological union in all cases was seen at a mean duration of 8 weeks. Full weight bearing was possible at a mean duration of 10 weeks (8-12 weeks). The results were excellent in 8 patients (67%) and satisfactory in 4 patients (33%). Complications that occurred were infection (2 cases), knee joint stiffness (4 cases), angulation <10 degrees (1 case), and shortening less than 10 mm (2 cases). Conclusions: Intramedullary fixation by TENS is an effective, time-tested treatment of fracture of the femur in patients of the 6-16 years age group.

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A clinical study of surgical management of distal femur fracture using locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193132 ◽

2019 ◽

Vol 5 (5) ◽

pp. 787

Author(s):

A. Varun Kumar Reddy ◽

S. Srikanth ◽

Gudapati Omkarnath

Keyword(s):

Clinical Outcome ◽

Traffic Accidents ◽

Distal Femur ◽

Road Traffic ◽

Weight Bearing ◽

Early Weight Bearing ◽

Non Union ◽

Femur Fractures ◽

Locking Compression Plates ◽

Fall From Height

Background: Fractures of distal femur are common due to increased road traffic accidents and fall from height because of increased construction activities. These fractures are quite disabling hence, these fractures necessitate early stabilization of fractures. Internal fixation with LCP has shown to give one of the best results in terms of recovery, fracture union, and clinical outcome. The aim of the study the clinical outcome of treatment of distal femur fractures using locking compression plates.Methods: A total of n=20 cases of distal femur fractures treated with LCP from December 2013 to June 2015 at NMCH and RC, Raichur. They were admitted and examined according to protocol clinically and radiologically. All patients were followed up for a minimum of 6 months and outcome assessed with Neer’s score.Results: All fractures healed with an average duration of 16 weeks which is comparable with other studies. We had two cases of varus collapse one was due to early weight bearing in one case and other case is due to gross communition. One case had an implant failure (plate breakage) due to early weight bearing. Cases needing hardware revision is comparable to other studies at 10%. Average Neer's knee score was 76.Conclusions: we have found higher Neer’s scores in this study. The LCP also prevents compression of periosteal vessels. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is a valuable technique in the management of these fractures. But however, in type C fractures the outcome is poorer.

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Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211055889 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110558

Author(s):

Martin Paulsson ◽

Carl Ekholm ◽

Eythor Jonsson ◽

Mats Geijer ◽

Ola Rolfson

Keyword(s):

Elderly Patients ◽

Distal Femur ◽

Plate Fixation ◽

Weight Bearing ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Femur Fractures ◽

Function Index ◽

The Mean ◽

Partial Weight

Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.

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Locked Plating Versus Spiral Blade Retrograde Nailing in Supracondylar Femoral Fractures

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80605 ◽

2012 ◽

Author(s):

Soroush Assari ◽

Alan Kaufman ◽

Kurosh Darvish ◽

Saqib Rehman ◽

Jung Park ◽

...

Keyword(s):

Bone Fractures ◽

Weight Bearing ◽

Femoral Fractures ◽

The Elderly ◽

Long Bone ◽

Supracondylar Fractures ◽

Locked Plating ◽

Early Weight Bearing ◽

Femur Fractures ◽

Retrograde Femoral Nailing

Comminuted supracondylar femur fractures in the elderly are often treated with either retrograde femoral nailing or locked plating. Early weight-bearing is typically restricted after fixing supracondylar fractures, thereby impairing the patient’s mobilization. In general, surgeons are more comfortable allowing early weight-bearing of long bone fractures after nailing rather than plating, but early studies of retrograde nails for supracondylar fractures using standard distal locking showed poor fixation compared with locked plating.

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