“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 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.

scholarly journals Locking Compression Plate in Distal Femoral Intra-Articular Fractures: Our Experience

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
G. N. Kiran Kumar ◽  
Gaurav Sharma ◽  
Kamran Farooque ◽  
Vijay Sharma ◽  
Ratnav Ratan ◽  
...  
Keyword(s):  
Femoral Fractures ◽  
High Energy ◽  
Lateral Approach ◽  
Excellent Outcome ◽  
Distal Femoral Fractures ◽  
Articular Fractures ◽  
Locking Compression Plates ◽  
The Mean ◽  
Low Incidence

Background. Intra-articular fractures of distal femur present a huge surgical challenge. The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intra-articular fractures using locking compression plates. Material and Methods. We reviewed 46 distal femoral fractures treated with distal femoral locking compression plates between 2009 to 2012. There were 36 men and 10 women with mean age of 35 years (range 20–72). More than half of the patients were of type C3 (AO classification) and had been caused by high energy trauma with associated injuries. Results. 2 patients were lost to follow-up. Of the remaining 44 patients, the mean follow-up period was 25 months (range 18–36). The mean time for radiological union was 12 weeks (range 10–18) except 2 patients which had gone for nonunion. At the latest follow up ROM >120∘ is noted in 32 patients, 90–120 in 10 patients, and 70–90 in 2 patients. 38 patients (86%) had good/excellent outcome. Conclusion. Use of standard lateral approach for simple intra-articular distal femoral fractures (C1) and transarticular/minimally invasive techniques for complex intra-articular fractures (C2/C3) results in improved exposure of the knee joint and better union rates with low incidence of bone grafting.

scholarly journals Minimally Invasive Plate Osteosynthesis with Dual Plating for Periprosthetic Distal Femoral Fractures Following Total Knee Arthroplasty

2020 ◽  
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 ◽  
One Year

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 one 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 one-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.

CLINICAL EVALUATION OF EFFICACY OF MINIMAL INVASIVE PLATE OSTEOSYN THESIS TECHNIQUE FOR SURGICAL MANAGEMENT OF SUPRACONDYLAR FEMUR FRACTURES

2021 ◽  
pp. 67-69
Author(s):  
Sumanta Panja ◽  
Mujibar Rahaman Mullick
Keyword(s):  
Distal Femur ◽  
Femoral Fractures ◽  
Locking Compression Plate ◽  
Osteoporotic Bone ◽  
Distal Femoral Fractures ◽  
Femur Fractures ◽  
Randomized Controlled Studies ◽  
Compression Plate ◽  
Supracondylar Femur Fractures

AIMS AND OBJECTIVES: To study Union rate (time to union), time of mobilization, functional results, radiological results, complications of supracondylar femur fractures treated by MIPO techniques with distal femur locking compression plate (DF-LCP). MATERIALANDMETHODS: This is a prospective study of 30 Patients, with supracondylar femur fractures (AO classication A) who were treated with distal femur locking compression plate (DF- LCP) by MIPO techniques at Department of Orthopaedics, SSKM & IPGMER KOLKATA from 1stJAN2015 to 31st JULY 2016.The study sample size was 30 patients and all these patients were included with predened inclusion & exclusion criteria in this study. Minimum of 12 months and a maximum of 17 months follow up were done. The functional and radiographic results were recorded according to Knee Society Score criteria. RESULTS: The average time to union was 3.93 months with a range of 2 – 7 months (8 – 28 weeks) and standard deviation being 1.13. The Mean range of exion obtained postoperatively was 108.830 with a range of 900– 1250. Six decreased knee movements, two mal-alignment, two implant failure and two infection were the residual complications in our study. Follow up of our cases included from a minimum of 12 months to a maximum of 17 months. Excellent results were seen in 3 cases, good in 10, fair in 12 and 5 case of poor results was seen. CONCLUSION: We conclude that MIPO technique with DF-LCP in distal femoral fractures is a safe and reliable option. It may substitute a conventional plate and screw system (compression method) in treatment of complex distal femoral fractures especially in osteoporotic bone. Further randomized controlled studies are required in different situations to know the usefulness of this implant.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

scholarly journals Tension band plates have greater risks of complications in temporary epiphysiodesis

2021 ◽  
Vol 15 (2) ◽  
pp. 106-113
Author(s):  
You-Hung Cheng ◽  
Wei-Chun Lee ◽  
Yi-Feng Tsai ◽  
Hsuan-Kai Kao ◽  
Wen-E Yang ◽  
...  
Keyword(s):  
Tibial Plateau ◽  
Distal Femur ◽  
Mechanical Axis ◽  
Valgus Deformity ◽  
Tension Band ◽  
Leg Length ◽  
Level Of Evidence ◽  
Grade Ii ◽  
Angular Deformities

Purpose This study aimed to compare the efficacy of decreasing leg-length discrepancy (LLD) and postoperative complications between tension band plates (TBP) and percutaneous transphyseal screws (PETS). Methods This retrospective study reviewed LLD patients who underwent temporary epiphysiodesis at the distal femur and/or proximal tibia from 2010 to 2017 (minimum two years follow-up). Efficacy of decreasing LLD was assessed one and two years postoperatively. Complications were classified with the modified Clavien-Dindo-Sink complication classification system. Knee deformities were assessed by percentile and zone of mechanical axis across the tibial plateau. Results In total, 53 patients (25 boys, 28 girls) underwent temporary epiphysiodesis (mean age, 11.4 years). The efficacy of decreasing LLD at two years between the TBP (n = 38) and PETS (n = 15) groups was comparable. Seven grade III complications were recorded in six TBP patients and in one PETS patient who underwent revision surgeries for knee deformities and physis impingement. Four grade I and two grade II complications occurred in the TBP group. The mechanical axis of the leg shifted laterally in the PETS group and medially in the TBP groups (+7.1 percentile versus -4.2 percentile; p < 0.05). Shifting of the mechanical axis by two zones was noted medially in four TBP patients and laterally in two PETS patients. Conclusion More implant-related complications and revision surgeries for angular deformities were associated with TBP. A tendency of varus and valgus deformity after epiphysiodesis using TBP and PETS was observed, respectively. Patients and families should be informed of the risks and regular postoperative follow-up is recommended. Level of evidence Level III

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 Biomechanical study on the stress distribution of the knee joint after distal femoral fracture malunion with residual varus-valgus deformity 

2020 ◽  
Author(s):  
Ming Li ◽  
Pan Hu ◽  
Lijie Ma ◽  
Di Zhang ◽  
Wenli Chang ◽  
...  
Keyword(s):  
Stress Distribution ◽  
Knee Joint ◽  
Femoral Fracture ◽  
Femoral Fractures ◽  
Valgus Deformity ◽  
Biomechanical Study ◽  
Lower Limbs ◽  
Neutral Position ◽  
Distal Femoral Fracture ◽  
Lateral Plateau

Abstract Background: To investigate the effect of residual varus and valgus deformity on the stress distribution of knee joint after distal femoral fracture malunion. Methods: Fourteen adult cadaver specimens with formalin were selected to establish the femoral fractures models, which were fixed subsequently at neutral position (anatomical reduction) and malunion positions (at 3 degrees, 7 degrees, 10 degrees valgus positions and 3 degrees, 7 degrees, and 10 degrees varus positions). The stress distribution on the medial and lateral plateau of the tibia was quantitatively measured using ultra-low pressure sensitive film technology. The change of stress distribution of knee joint after femoral fracture malunion and the relationship between stress value and residual varus varus or valgus deformity were analyzed.Results: Under 400 N vertical load, the stress values on the medial and lateral plateau of the tibia at the neutral position were 1.162±0.114 MPa and 1.103±0.144 MPa, respectively. When compared with the stress values measured at the neutral position, the stress on the medial plateau of tibia were significantly higher at varus deformities and lower at valgus deformities, and the stress on the lateral plateau was significantly higher at valgus deformity and lower at varus deformities (all P<0.05). The stress values on the medial plateau of tibia were significantly higher than the corresponding data on the lateral plateau at neutral and 3 degrees, 7 degrees, 10 degrees varus deformities, respectively (all P<0.05), and significantly lower than the corresponding data on the lateral plateau at 3 degrees, 7 degrees, 10 degrees valgus deformities, respectively (all P<0.05). Conclusions: Residual varus and valgus deformity after femoral fracture malunion can cause obvious changes of the stress distribution of knee joint. Therefore, the distal femoral fracture should be anatomically reduced and rigidly fixed to avoid residual varus-valgus deformity and malalignment of lower limbs.

Sign in / Sign up

Export Citation Format

Share Document