Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen

Purpose:Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1%of all fractures.Open fracture takes 5%-10%of the all distal femoral fractures,which is at an increased risk of complications.There were limited studies which documented the outcomes of such cases.The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India.Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.They were followed for minimum of six months.Patients were followed up monthly for first four months,at six months and one year after surgery.Clinical and radiological signs of healing,any complications,time to union,and functional outcome were assessed.Results:The mean age of patients was 44.33 years(range 20-82 years)with male predominance of 66.7%.According to Gustilo-Anderson classification,there were 5,15 and 10 patients with open grade I,II and IIIA distal femoral fractures respectively.According to orthopaedic trauma association(OTA)classification,majority of patients in our study were of C3 type.The mean time to bony union was 5.6 months(range 4-9 months).Average postoperative knee range of motion(ROM)at the latest follow-up was 98°(range 70°-120°).Lysholm knee scoring scale showed excellent score in 11 patients,good in 9 patients,fair and poor in 5 patients each;however,there was no significant correlation with fracture pattern types(p<0.05).Knee stiffness was the major complications encountered in the study.The knee ROM was<90°in 5 patients and 90°-120°in rest of the patients,while 1 patient had extensor lag of 10°.One patient had implant failure and lost to follow-up;3 patients had deep infection.Conclusion:An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.

Distal femur complex fractures in elderly patients treated with megaprosthesis:Results in a case series of 11 patients

BACKGROUND Surgical treatment of complex fractures of the distal femur in the elderly is controversial.Osteoporosis and pre-existent osteoarthritis are common comorbidities in the elderly which add to the need for early walking and rapid restoration of function and also pose significant obstacles to achievement of satisfactory results with standard fixation techniques.Recently,several authors have suggested that primary arthroplasty could be a viable alternative option to standard fixation techniques in selected patients with complex distal femur fractures.AIM To present our experience with 11 cases of distal femur fractures treated with knee arthroplasty and large femoral resection in a population of patients over the age of 85.METHODS Data from 11 consecutive patients(10 females,1 male)presenting with acute intra-articular supracondylar or intercondylar distal femur fractures and with pre-existent primary osteoarthritis who were treated with primary knee arthroplasty were recorded.We collected standard demographic data,comorbidities and patient reported outcomes including Visual Analogical Scale(VAS),Oxford Knee Score(OKS)and Barthel’s Index.Post-operative joint range of motion(ROM)and standard radiographic data were also collected.RESULTS At a mean follow-up of 23.2 mo,all of the implants were well-positioned and osteointegrated.Furthermore,all the patients were alive and walking either independently or with walking aids.There was a marked improvement in pain(VAS 4.5 postop vs 1.9 at the last follow-up),OKS score(29.5 postop vs 36.81 at the last follow-up),ROM(96.2°postop vs 102°at the last follow-up)and restoration of pre-injury ambulatory status(average Barthel Index 77.3).The radiographic evaluations showed good restoration of the articular geometry.No deaths and no complications were recorded.CONCLUSION In conclusion,we believe that knee megaprosthesis in the case of complex fractures of the distal femur is a valid surgical choice.This is particularly true in elderly patients with severe osteoporosis and pre-existing osteoarthritis.It is important to note that this surgery should be performed by surgeons with proven experience in prosthetic hip and knee surgery and that a scrupulous selection of the cases is completed.