Evaluation of functional outcome following ORIF with Distal femoral locking plate in Intraarticular fractures of the distal femur

Fractures of the distal femur are high-velocity injuries and are associated with factors such as fracture comminution and osteoporosis, especially in elderly individuals which are quite challenging to manage. Various implants and techniques are available for the surgical management of these fractures. This study was performed to evaluate the functional outcome of these fractures following ORIF (Open reduction and internal fixation) with the DFLP (Distal femoral locking plate). Thirty patients with distal femoral intraarticular fractures who presented between February 2013 to February 2016 were managed by ORIF with DFLP and were followed up for three years. Functional evaluation was performed using the Neers scoring system. The average age of the patients was 38.06 years ranging from 22 to 64 years. There were twenty-one males, and nine females seen in our study with the right side being more commonly affected. We achieved a 100% union rate in our series with the meantime to fracture union being 12.86 weeks. We had excellent results in 65% of patients and satisfactory results in 35% of patients with minimal complications. ORIF with the DFLP is a unique biological fixation option in intraarticular fractures of the distal femur, and it provides for reasonable rates of fracture union and an excellent functional outcome with minimal complications.

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Reverse distal femoral locking plate for subtrochanter femur fracture

Medical Journal of Indonesia ◽

10.13181/mji.v27i2.1377 ◽

2018 ◽

Vol 27 (2) ◽

Author(s):

Peter Giarso ◽

Ismail H. Dilogo

Keyword(s):

Distal Femur ◽

Locking Plate ◽

Femur Fracture ◽

Case Series ◽

Subtrochanteric Fracture ◽

Locking Compression Plate ◽

Non Union ◽

Functional Scores ◽

The Right ◽

Subtrochanteric Femur Fracture

In these case series, we used titanium locking compression plate-distal femur (LCP-DF) plate (Synthes) 9–11 hole using less invasive stabilization system or open reduction technique. This case series aims to determine the functional scores on reverse distal femoral locking plate for subtrochanteric femur fracture. A 34-year-old male with closed subtrochanteric fracture of the right femur (Seinsheimer 2B) with Harris hip scores (HHS) of 17, 96, and 97 obtained consecutively in 0, 6, and 12 months, respectively. A 24-year-old male with closed comminuted subtrochanteric fracture of the right femur (Seinsheimer V) with HHS of 13, 93, and 97 at 0, 6, and 12 months respectively. A 39-year-old male with non-union, left subtrochanteric femur fracture (Seinsheimer 2C) yielded HHS of 38, 73, and 77 at 0, 6, and 12 months, respectively. A 35-year-old female with close subtrochanteric fracture of the right femur (Seinsheimer IIB) yielded HHS of 23, 40, and 73 at 0, 6, and 12 months, respectively. Mean initial HHS and scores at 6 and 12 months reached 22, 75, and 86, respectively.

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Fixation of proximal humerus fracture in adult by locking plate: Clinical study

Surgical Update: International Journal of Surgery and Orthopedics ◽

10.17511/ijoso.2020.i05.07 ◽

2020 ◽

Vol 6 (5) ◽

pp. 325-332

Author(s):

Dr. Vivek Amritbhai Patel ◽

◽

Dr. Vishal A. Pushkarna ◽

Dr. Dhruvin J. Patel ◽

◽

...

Keyword(s):

Functional Outcome ◽

Proximal Humerus Fracture ◽

Locking Plate ◽

Proximal Humerus ◽

Plate Fixation ◽

Humeral Fracture ◽

Humerus Fracture ◽

Functional Evaluation ◽

Locking Plates ◽

Radiological Union

p>Aim: The present study aimed to examine the functional outcome of the locking plate in theproximal humerus fracture treatment. Material and Methods: The study consists of 20 patientsdiagnosed with NEER’s 2 – part, 3- part, and 4 – part proximal humerus fracture. All the includedpatients were treated with internal locking plates. Based on the functional evaluation by Constant-Murley shoulder score and the assessment of radiological union foundation. Results: Excellentresults were obtained in 45% of the patients, a good result was seen in 25%, 20% of the patientshad fair results and the poor result was seen in 10% of the patients. The mean Constant-Murleyshoulder score that was obtained in the present study was 75.04. Conclusion: It’s concluded thatthere is a satisfactory functional outcome with the fixation of the proximal humerus fracture withlocking plates. While using the plate fixation for fracture the plate position is of the utmostimportance. Due to angular stability, the locking plates are the advantageous implants in case ofproximal humeral fracture.

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A clinical study in distal femur fractures management with locking compression plate without C-arm images

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193828 ◽

2019 ◽

Vol 5 (5) ◽

pp. 875

Author(s):

Gaurav Singla

Keyword(s):

Functional Outcome ◽

Distal Femur ◽

Locking Plate ◽

Imaging Modality ◽

Femoral Fractures ◽

Locking Compression Plate ◽

Anatomical Location ◽

Anatomical Reduction ◽

Femur Fractures ◽

Compression Plate

Background: Distal femur fractures pose a surgical challenge to the orthopaedic surgeons. Multiple implants are available but locking compression plate is a good implant to be used in this anatomical location. LCP may reduce the tendency of varus collapse and offers higher stability than other implants. Aim of our study was to review functional outcome, union time and complications in distal femoral fractures treated with distal femoral locking plate without C-arm imaging modality.Methods: 25 patients with closed or open type grade1 and 2 distal femur fractures managed with open method locking compression plate without C-arm image. Pritchett rating system was used for evaluation of outcome.Results: All patients in this series united well with an average time of 13 weeks with minimal complications. Functional outcome was excellent in 4 patients, good in 19 patients, fair in 2 patients.Conclusions: Open reduction and locking compression plate is suitable implant available for fixation of distal femur fractures with minimal complications. Even it can be done without C-arm. Surgical technique and proper anatomical reduction and alignment are the key for good results.

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A prospective study of functional outcome of distal femur fractures by locking plate

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i1g.1889 ◽

2020 ◽

Vol 6 (1) ◽

pp. 359-363

Author(s):

Dr. Abhishek Shenoy ◽

Dr. Anil Bulagond ◽

Dr. OB Pattanashetty ◽

Dr. Dayanand BB

Keyword(s):

Prospective Study ◽

Functional Outcome ◽

Distal Femur ◽

Locking Plate ◽

Femur Fractures ◽

A Prospective Study

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Open complex distal femur intraarticular fracture with Hoffa extension, extensor mechanism tear and post-recovery secondary traumatic peri implant fracture: report on an uncommon chronology

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20204609 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1335

Author(s):

Lavindra Tomar ◽

Gaurav Govil ◽

Pawan Dhawan

Keyword(s):

Functional Outcome ◽

Distal Femur ◽

Extensor Mechanism ◽

Wound Management ◽

Bony Defect ◽

Biological Fixation ◽

Early Presentation ◽

Golden Hour ◽

Femur Fractures ◽

Early Return

Complex distal femur fractures with Hoffa’s extension are uncommon. An associated open fracture with extensor mechanism disruption are rarely reported. A secondary post-traumatic post-recovery peri-implant fracture is a rare presentation. 28-year-old pilon rider male sustained open complex fracture of left metaphyseal distal femur with Hoffa extension and tear in extensor mechanism. He was treated within a golden hour period of wound management. Primary stabilization by distal femoral locking plate and cannulated cancellous screw was done along with primary bone grafting and repair of extensor mechanism. At sixteen weeks, clinic-radiological progression allowed him his pre-injury activities. At seven months, a second trauma resulted in a non-prosthetic peri-implant femoral fracture, another unusual occurrence. Re-osteosynthesis with grafting was done. At twenty months of the primary injury, there was good functional outcome with a painless range of knee flexion to 130° without any extensor lag. Open complex distal femur injury with an associated secondary hit peri-implant fracture presented with significant challenges in management of soft-tissue and reconstruction of bony defect. The early presentation within a golden hour period allowed an early injury assessment to implement primary biological fixation as a treatment modification. Aim was to achieve favorable functional outcome which allowed early return to pre-injury status.

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RADIOLOGICAL AND FUNCTIONAL OUTCOME OF DUAL PLATING IN DISTAL FEMUR MULTIFRAGMENTARY ARTICULAR FRACTURES: A SHORT TERM STUDY

10.36106/gjra/5801185 ◽

2021 ◽

pp. 31-35

Author(s):

V J Purushotham ◽

Abhishek Patil

Keyword(s):

Functional Outcome ◽

Distal Femur ◽

Femoral Fractures ◽

Long Bone ◽

Femur Fractures ◽

Articular Fractures ◽

Dual Plating ◽

Classi Cation ◽

Excellent Functional Outcome ◽

Operative Indications

Introduction: In this prospective cases series, we are reporting a mean 12-month follow up of the utilisation of dual plating technique for multi fragmentary articular distal femur fractures. Our technique consists of a lateral distal femoral locked plate and a low prole locked medial plate through a modied anterior (Swashbuckler) approach for the xation of C2, C3 fractures. Patients and Methods: 15 patients (9 males and 6 females) presented with supra condylar femoral fractures type C2/C3, according to Müller long bone classication and its revision, OA/OTA classication. These fractures were treated using dual plating through swashbuckler approach. They were followed up for clinical and radiological outcomes. Secondary outcomes included post-operative complications. Results: Mean time of radiological union in studied population was 18 weeks with a range of 14-24 weeks. We did not observe any post-operative varus angulation.12 out of 14 patients had good to excellent functional outcome. Fair outcome was reported in only two patients Conclusion: The technique of Dual plating xation using modied anterior approach (swashbuckler) for type C2,C3 distal femoral fractures is an efcient method of management. It has several advantages such as precise exposure, easy manipulation, anatomical reduction and stable xation. However, operative indications and principles should be strictly followed. The surgical technique must be perfect and the biomechanical qualities of the implants must be understood to prevent the development of major complications

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Reconstruction of complex distal femur open fracture with distal femoral locking plate and primary autologous free fibular graft

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173943 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1066

Author(s):

Rajagopal H. P. ◽

Madan Mohan M. ◽

Anoop Pilar ◽

Keith Behram Tamboowalla

Keyword(s):

Functional Outcome ◽

High Velocity ◽

Open Fracture ◽

Distal Femur ◽

Locking Plate ◽

Road Traffic ◽

Fibular Graft ◽

Wound Debridement ◽

Femur Fractures ◽

Koos Score

Background: Distal femur fractures are high velocity injuries which accounts for 7-10% of all femoral fractures. These injuries are complex injuries which are difficult to manage. Despite advances in techniques and implants, treatment remains a challenge, in many situations.Methods: We present a retrospective review of 8 cases, involved in high velocity road traffic accident who presented to emergency department at St. John’s Medical College, Bangalore, Karnataka, India between September 2011 to December 2015, with complex open fracture of the distal femur with bone loss. All were managed with initial wound debridement and skeletal traction. Subsequently fractured femur was reconstructed with distal femoral locking plate stabilization, along with autogenous non vascularised fibular graft and cortical-cancellous graft bridging the bone defect. Radiological union, functional outcome measured with Tegner and Lyslom scores, KOOS score and complications were assessed.Results: At average 5 years follow up, all the fractures have united well, with good functional outcome. X-ray showing united fracture with incorporation of the fibular graft. According to Tegner and Lyslom scoring, 6 patients had good rating, 2 had satisfactory rating. Average KOOS score was 82.15. Shortening of 2 cm and 4 cm in couple of patients was the major complication. Conclusions: Delayed primary surgery, using autologous non vascularised free fibular graft in conjunction with a locking compression plate, with autogenous cortico-cancellous graft is an effective, less technically demanding and cost effective means of reconstruction option to manage bone defects in complex open fractures of the distal femur. An overall acceptable results in terms of fracture union, fibular incorporation, adequate restoration of knee motion and early rehabilitation can be expected.

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Fractures of metacarpal bone: evaluation of functional outcome of open reduction and internal fixation with mini locking plate: a hospital based study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20191795 ◽

2019 ◽

Vol 5 (3) ◽

pp. 519

Author(s):

Arumugam A. Kandasamy ◽

Mozammil Pheroz ◽

Arvind Kumar ◽

L. G. Krishna ◽

Ankit Jain ◽

...

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

Locking Plate ◽

Delayed Union ◽

Rigid Fixation ◽

Functional Evaluation ◽

Metacarpal Fractures ◽

Surgical Methods ◽

Metacarpal Bones

Background: Metacarpal bones fracture is very common. Management of metacarpal fractures varies from conservative to percutaneous pinning to various surgical methods. We endeavour to evaluate the functional outcome of metacarpal fractures in patients managed with open reduction and internal fixation with mini locking plate.Methods: A total of 32 patients with extra-articular metacarpal bones fracture were recruited for the study. After open reduction the fractures were fixed with the mini locking plate, postoperative day 3, plaster removed and active and passive exercises started. The Michigan hand score was used for functional evaluation, grip strength, visual analogue scale score, range of motion evaluated at follow up till six months.Results: All the 32 patients achieved union, 31 had full union at 6 weeks whereas 1 patient has delayed union. The Michigan hand outcome questionnaire score of 97.5 % at 6 months in all 32 patients. A total of 5 out of 32 patients had complications, the most common being finger stiffness followed by superficial infection and delayed union.Conclusions: We concluded that metacarpal plating with mini locking plate is a good option to achieve and maintain a rigid fixation and this method produces a better outcome in unstable fractures of metacarpal bones.

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Retrograde intramedullary nailing for fractures of distal femur: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20164003 ◽

2016 ◽

Vol 2 (4) ◽

pp. 276 ◽

Cited By ~ 1

Author(s):

Dileep K. S. ◽

Mahesha K

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Intramedullary Nailing ◽

Distal Femur ◽

Rating Scale ◽

X Rays ◽

Fracture Union ◽

Retrograde Intramedullary Nailing ◽

Interlocking Nailing ◽

Secondary Procedures

Background: The objective of the present study was to evaluate the clinical and functional outcome of retrograde intramedullary interlocking nailing for fractures of distal femur.Methods: This two-year prospective observational study includes all patients with fractures of distal femur who underwent retrograde intramedullary interlocking nailing. The patient was placed supine on fracture table with the affected limb flexed to 60o. Through a transpatellar approach, the nail was introduced in a retrograde method after serial reaming. Postoperatively knee range of motion was started immediately and weight-bearing was progressed after signs of fracture union were noted on x-rays. The outcome was evaluated for time taken for fracture union, complications and secondary procedures, knee range of motion and function at 1 year follow up using modified knee-rating scale of the hospital for special surgery.Results: There were 21 patients who underwent retrograde intramedullary nailing for fractures of distal femur during the study period. According to AO/ASIF system, fractures were classified as A1 (n=15), A2 (n=3), and A3 (n=3). In 17 patients, fracture united without complications or secondary procedures. Fractures united at a mean time of 19.4 weeks. There were no varus or valgus malalignments but one patient had significant limb shortening. At the end of 1 year, excellent to good functional outcome was noted in 81% of patients. Conclusions: Retrograde intramedullary nail fixation is a reliable method for treatment of fractures of distal femur. It promotes high rates of fracture union with minimal complications. This method does not interfere significantly with the knee function postoperatively.

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Successful sterilization and immediate reimplantation of extruded femoral diaphyseal segment: A case report and review of literature

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1177/2210491720963288 ◽

2020 ◽

pp. 221049172096328

Author(s):

Vivek Sodhai ◽

Chetan Pradhan ◽

Parag Sancheti ◽

Ashok Shyam

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Bone Grafting ◽

Distal Femur ◽

Locking Plate ◽

Treatment Strategies ◽

Definitive Treatment ◽

Functional Score ◽

Good Functional Outcome ◽

Bone Segment

Extrusion of bone is a rare situation in open fractures due to high energy trauma. There are few studies, reporting successful reimplantation of the extruded bone segment using various sterilization and fixation protocols. However, there are no definitive treatment strategies for this challenging situation. We report a case of 30-year-old male patient with grade IIIB compound right distal femur fracture with an extruded long bone segment, who was treated with successful sterilization and immediate reimplantation of an extruded long diaphyseal segment of distal femur following extensive cleaning with sterile normal saline, removal of debris with scrubbing by sterile brush, soakage in the broad-spectrum antimicrobial solution for 30 min, sterilization by autoclaving at 121°C for 45 min, and reimplantation during stable internal fixation with lateral distal femur locking plate using Arbeitsgemeinschaft für Osteosynthesefragen techniques. At 3 months, iliac crest bone grafting, osteoperiosteal flaps, and augmented fixation with a medial locking plate were performed through a subvastus approach for a void in the medial supracondylar femur region. Intraoperatively, punctate bleeding was observed from the reimplanted fragment. Infection was ruled out with normal leukocyte count, C-reactive protein marker, no evidence of unhealthy granulation tissue, and a sterile culture report from the fracture site. The fracture healed in 12 months and the patient had good functional outcome with a lower extremity functional score of 80% and knee range of motion of 110° at short-term follow up of 2 years without any complication. Decision of reimplantation is individualized depending on the time of presentation, contamination, and comminution of extruded fragment with scarce literature on standard treatment strategies. In our case, early presentation, meticulous debridement, unique sterilization technique, immediate reimplantation, and augmented dual distal femur plating with bone grafting aided in achieving successful union with good functional outcome and knee range of motion, avoiding any complications.

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