Comparison of Outcome with RNVL Compressive Plating in the Treatment of Extra Articular Supracondylar Femur Fractures

Objective: To compare outcome of retrograde nailing versus locked compressive plating in the treatment of extra articular supracondylar femur fractures. Study Design: A randomized prospective trial. Place and Duration of the Study: Department of Orthopedic Surgery, Ghurki Hospital, Lahore, Pakistan from January 2020 to November 2021. Methodology: A total of 160 (80 in each group) patients aged between 18 to 50 years of both genders with extra articular supracondylar femur fractures were randomized into either retrograde nailing group (Group-A) or locked compressive plating (Group-B). Surgery time and functional outcome were compared in both groups. Demographic characteristics along with mean surgery time and functional outcomes were compared between both study groups. Results: In a total of 160 patients, mean age was 33.57±9.45 years. The mean age in Group-A was 33.24±8.61 years and in Group-B 33.90±10.26 years. In group-A, there were 49 (61.25%) male and 31 (38.75%) female cases while in group-B there were 56 (70%) male and 24 (30%) female cases. The mean surgery time in group-A was significantly less as compared to group-B (83.29±7.48 minutes vs. 106.62 ± 7.69 minutes, p<0.01). The frequency of excellent to good outcome was statistically higher in Group-A as compared to Group-B (p< 0.05). Conclusion: Retrograde nailing gave better results in the treatment of extra articular supracondylar femur fractures when compared with locked compressive plating. Retrograde nailing can be opted to reduce the surgery time and gain better functional outcome. Keywords: Femur fracture, nailing, plating, surgery time, functional outcome

Outcome of Retrograde Nailing in the Treatment of Extra Articular Supracondylar Femur Fractures

Objective: To find out outcome of retrograde nailing in the treatment of extra articular supracondylar femur fractures. Study Design: A prospective observational study. Place and Duration of the Study: The Department of Orthopedic Surgery, Ghurki Hospital, Lahore, Pakistan from January 2020 to August 2021. Methodology: A total of 92 patients of both genders aged 18 to 50 years with supracondylar femur fractures and supracondylar fractures with fracture line extending to distal third of femoral shaft were enrolled. Retrograde nailing was performed among all patients. Surgery time and functional outcome were noted. All surgeries were accomplished under spinal/epidural or general anaesthesia. Results: Out of a total of 92 patients, there were 59 (64.1%) were male and 33 (35.9%) female. Overall, the mean age of patients was 33.12±9.08 years. The mean surgery time was noted to be 85.29±7.48 minutes. A total of 85 patients completed the designated period of 12-weeks for the evaluation of functional outcome. Excellent outcomes were observed in 47 (55.3%) cases, good 25 (29.4%), fair 9 (10.6%) and poor in 4 (4.7%) cases. Excellent to good outcomes were observed in 72 (84.7%) cases. Conclusion: Retrograde nailing had good outcomes in the treatment of extra articular supracondylar femur fractures. Keywords: Femur fracture, nailing, surgery time, functional outcome.

The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures

Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs: Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws? Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length? Does fracture working length affect construct stiffness given the same plate material, length and type of screws? Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws? Methods Mechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus. Results Stiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness. Discussion Using shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown.

CLINICAL EVALUATION OF EFFICACY OF MINIMAL INVASIVE PLATE OSTEOSYN THESIS TECHNIQUE FOR SURGICAL MANAGEMENT OF 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.

A prospective study on surgical fixation of complex supracondylar femur fracture with distal femoral locking compression plate: our experiences at a tertiary care centre

<p class="Default"><strong>Background: </strong>The optimal treatment of complex supracondylar femur fractures remains always challenging and controversial. the purpose of this prospective study was to evaluate the efficacy of distal femoral locking compression plate (DF-LCP) in terms of functional outcome and union rate for highly unstable complex supracondylar femur fractures and to determine the influencing factors of an unfavourable outcome.</p><p><strong>Methods:</strong> After obtaining approval from institutional ethics committee, 45 patients with complex supracondylar femur fractures were managed by open reduction and internal fixation with DF-LCP through lateral approach and as per standard protocol. The follow-up results were analysed clinically and radiologically, using the “Schatzker and Lambert criteria” at once in a month for first three months, once in three months up to one year and once in six months thereafter up to 2 years post-operatively.</p><p><strong>Results:</strong> In the present study, average duration of radiological union was 16 (range 12-22) weeks. The average range of motion of knee joint was 105 degrees. Out of 45 patients, clinical results were excellent in 48.9%, good in 17.8%, fair in 22.2% and poor in 11.1% patients according to Schatzker and Lambert criteria. Knee stiffness (7 cases), secondary arthritis (5 cases), and non-union (4 cases) were the main complications observed in this study, which were treated accordingly.</p><p><strong>Conclusions: </strong>DF-LCP holds the metaphyseal bone strongly and prevents metaphyseal collapse and mal-rotation in complex or highly unstable supracondylar femur fractures and simultaneously, it provides stable fixation to promote fracture union and allows early rehabilitation with acceptable complications.</p>

External fixation and Kirschner wires in the treatment of paediatric displaced supracondylar femur fractures

Purpose Kirschner-wire fixation (KF) and external fixation (EF) for the treatment of displaced supracondylar femur fractures (SFFs) were demonstrated respectively in previous reports. However, there is no paucity of convincing information on better treatment options for children. The aim of this study was to show results of KF and EF in the treatment of paediatric SFFs according to clinical and radiological outcome. Methods A retrospective analysis including 22 displaced closed SFFs was performed. A total of 12 patients were treated with KF, other ten patients were treated with EF. All patients were followed up for at least 24 months. Demographic data, surgical outcomes and postoperative knee function using the Knee Society Score (KSS) scale were evaluated in this research. Results The patients in the KF group were significantly younger than in the EF group (p < 0.001). The KF group had superiority in operative time (p = 0.001), blood loss (p = 0.027) and length of hospital stay (p = 0.001). Clinical healing outcome did not differ between the two groups. The KF group achieved radiological union in a shorter period (p < 0.001), with a better range of movement (ROM) and KSS postoperative score. Conclusion Both KF and EF can achieve excellent outcomes for paediatric SFFs. KF has many advantages in younger children. Level of Evidence IV