OUTCOMES OF OPEN FRACTURES OF LONG BONE

Main Article Content

Dr Sanjay Agarwal
Dr Manoj Kumar Patel

Keywords

Distal Femur, Open Fractures of Distal Femur, Operative Outcomes of Distal Femur

Abstract

Introduction- Open fractures of the distal femur are a uncommon and intricate type of injury that typically occur in individuals who have sustained multiple traumas. These types of fractures are often accompanied by bone loss, contamination, damaged soft tissue, and a patient's overall poor health condition. The purpose of this study is to examine the outcomes of patients who were treated for open distal femur fractures using a staged protocol, which involves initial external fixation with debridement, followed by definitive fixation using an anatomical locking plate and bone grafting at a later stage.


Method- The study included a group of 20 patients of open distal femurfractures who were operated with temporary external fixator and later on converted to definitive fixation with condylar locking plate with bone grafting. These patients were operated with our staged protocol and clinical outcome was evaluated using the functional evaluation scoring system by Sander’s et al and Knee Society Scoring. Out of these 20 patients, 1 was lost to follow up at 3 months and 2 others were lost to follow up at 6 months. These 3 were excluded from our study.


Results- Fracture union was seen in all 17 patients. The average time to union was 22.65+3.3 weeks. Two patients were complicated with infection and delayed union. Ilizarov application was doneto achieve union and gain length once the infection subsided.


Conclusion- Staged protocol of temporary external fixator followed by definitive fixation with condylar locking plate and bone grafting is a safe and reliable method for the management of open distal femur fractures.

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References

1. Hoskins W, Sheehy R, Edward ER, Hau RC, Bucknill A, Parsons N, Griffin XL. Nails or plates for fracture of the distal femur? Data from the Victoria Orthopaedic Trauma Outcomes Registry. Bone Joint J. 2016; 98-B:846-850.
2. Hoffmann MF, Jones CB, Sietsema DL, Tornetta P, Koenig SJ. Clinical Outcomes of locked plating of distal femoral fractures in a retrospective cohort. J OrthopSurg Res. 2013; 8:43.
3. Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. ActaOrthop Scand. 1982;53:957-962.
4. Papadokostakis G, Papakostidis C, Dimitriou R, Giannoudis PV. The role and efficacy of retrograde nailing for the treatment of diaphyseal and distal femoral fracturers: a systematic review of the literature. Injury. 2005;36:813-822.
5. Martinet O, Cordey J, Harder Y, Maier A, Buhler M, Barraud GE. The epidemiology of fractures of the distal femur. Injury. 2000;31:62-63.
6. Meek RM, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg[Br]. 2011;93:96-101.
7. Auffarth A, Bogner R, Koller H, Tauber M, Mayer M, Resch H et al. How severe are initially undetected injuries to the knee accompanying a femoral shaft fracture? J. Trauma. 2009;66:1398-1401.
8. Stewart MJ, Sisk TD, Wallace SL. Fractures of the distal third of the femur. A comparison of methods of treatment. J. Bone Jt. Surg. 1966;48-A:784-807.
9. Dugan TR, Hubert MG, Siska PA, Pape HC, Tarkin IS. Open supracondylar femur fractures with bone loss in the polytraumatized patient – Timing is everything! Injury, Int. J.Care Injured. 2013;44:1826-1831.
10. Arazi M, Memik R, Ogun TC, Yel M. Ilizarov external fixationfor severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Joint Surg[Br].2001;83-B:663-667.
11. Kumar P, Singh GK, Singh M, Bajraacharya S. Treatment of Gustilo grade IIIB supracondylar fractures of the femur with Ilizarov external fixator. ActaOrthop. Belg. 2006; 72: 332-336.
12. Parekh AA, Smith WR, Silva S, Aqudelo JF, Williams AE, Hak D, Morgan SJ. J Trauma. 2008;64(3): 736-739.
13. Sanders R, Swiontkowski M, Rosen H, Helfet D. Double plating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg Am. 1991;73(3):341-346.
14. Rorabeck CH, Taylor JW. Periprosthetic fractures of the femur complicating total knee arthroplasty. OrthopClin North Am. 1999;30:265-277.