To study the outcome of Fixation and reconstruction of distal femoral (supracondylar) open Fractures with bone loss using Distal femoral locking plates and autologous, non vascularized

Dr Naresh Rana

Volume : X, Issue : II, February - 2020

To study the outcome of Fixation and reconstruction of distal femoral (supracondylar) open Fractures with bone loss using Distal femoral locking plates and autologous, non vascularized

Dr Naresh Rana

Abstract :

Objectives: To study the outcome of Fixation and reconstruction of distal femoral (supracondylar) open Fractures with bone loss using Distal femoral locking plates and autologous, non vascularized fibular strut and cortico–cancellous bone grafting. Introduction: Distal femur fractures are difficult, complex injuries that can result in devastating outcomes. The intra–articular injury can vary from a simple split to extensive comminution. Articular involvement can lead to posttraumatic arthritis. These fractures constitute 4% to 7% of all femur fractures. There is a bimodal distribution defined by the mechanism of injury. They are complex injuries that are difficult to manage; despite advances in technique and improved implants, treatment remains a challenge in many situations. The goal of any treatment is to maintain or restore the congruity of the articular surface and restore the length and alignment of the femur and subsequently the limb. Methods and material: 15 patients(30–35 Years, all Male) involved in high velocity road traffic accident and Fall who presented to emergency department at Government Medical College Jammu, India, between June 2018 to June 2019, with open fracture of the distal femur with bone loss (severe bone loss in 11 patients and moderate loss in 4) were included in the study. All were managed with initial wound deidement and above knee slab/external fixator. Subsequently fractured femur was reconstructed with distal femoral locking plate stabilization, along with autologous non vascularised fibular Strut graft and cortical–cancellous graft idging the bone defect. Single free fibular strut was used in all patients with autologous cortico–cancellous bone grafting in all. Clinical union, radiological union, and knee function were assessed. Results: The period of follow up was 12 months. The average duration of hospital stay was 10 days. The time taken for radiological union in our study ranges from 14 weeks to 19 weeks with a mean of 13.5 weeks. 9 patients had more than 100° of knee flexion and 6 patients had less than 100 degree. The minimum flexion obtained was 70° and maximum being 120° There were 2 patients with varus angulation of 10 and 15°. Mean limb shortening was 2 cms . No limb shortening was observed in five patients. Patients were pain free and had no significant graft or donor site morbidity. Complication included 1 case of non–union and 1 case of superficial wound infection which subsided with antibiotics. 3 cases with extensor lag with an average of 6°. Functional assessment after union revealed two patient with excellent knee function, 11 good, and two poor function according to Sanders scoring. Conclusion: Staged fibular strut grafting and cortico–cancellous bone grafting appears to be a good treatment option for traumatic open supracondylar femoral fractures with significant bone loss.