Kumar Rakesh, Mohapatra Soumya Shrikanta, Joshi Narendra, Goyal S K, Kumar Kamlesh, Gora Rajendra
Department of Orthopaedics, S M.S. Medical College, Jaipur, 302004, India.
J Clin Orthop Trauma. 2019 Sep-Oct;10(5):928-933. doi: 10.1016/j.jcot.2019.01.026. Epub 2019 Jan 30.
Open comminuted distal femur fractures are notorious for septic or aseptic non-union. The recommended fixed angle distal femur locking plate in such situations can lead to a septic non-union due to its extensive approach and further periosteal stripping. Supracondylar nails, though have a minimally invasive approach, are not suitable for type C2 and C3 (AO/ASIF) fractures. A monolateral fixator as damage control followed by plating may be recommended. But if wound healing is delayed it results in difficult articular reduction, poor alignment and a stiff knee. We therefore used ilizarov circular external fixators (ICEF) for such open fractures (type C1, C2 and C3) and analysed its radiological and functional outcomes.
25 male patients, with a mean age of 31.04 ± 6.62 years (range, 22-44 years), with open grade III type C distal femoral fractures were treated with ICEF. There were 7 fractures of type C1and C3 each, 11 were of type C2. Articular reduction and compression was achieved with inter-fragmentary screws through minimal open technique by extending the open wound and then stabilising the fracture with ICEF. The main outcomes evaluated were union, range of motion, final shortening, Knee Society scoring and ASAMI scoring system for radiological and functional outcomes.
The mean follow-up period was 19.12 ± 1.14 months. All fractures except two united at a mean period of 30 ± 3.02 weeks, without the need of bone grafts. The bony assessment (according to ASAMI score) was excellent in 8 cases (33.33%), good in 9 cases (37.5%) and fair in 5 cases (20.83%), while there were 2 poor clinical end results. The functional results were excellent in 6 cases (25%), good in 9 cases (37.5%) fair in 6 cases (25%) poor in 3 cases (12.5%). The complications included shortening, extension lag and pin tract infections.
With the encouraging results, the use of ICEF with minimal internal fixation in grade III open comminuted distal femur fractures as a primary definitive treatment is a valuable alternative.
开放性粉碎性股骨远端骨折因感染性或无菌性骨不连而声名狼藉。在这种情况下，推荐使用的股骨远端锁定钢板固定角度，因其广泛的手术入路和进一步的骨膜剥离，可能导致感染性骨不连。髁上髓内钉虽然手术入路微创，但不适用于C2和C3型（AO/ASIF）骨折。可推荐使用单侧外固定器作为损伤控制，随后进行钢板固定。但如果伤口愈合延迟，则会导致关节复位困难、对线不良和膝关节僵硬。因此，我们使用伊利扎洛夫环形外固定器（ICEF）治疗此类开放性骨折（C1、C2和C3型），并分析其影像学和功能结果。
25例男性患者，平均年龄31.04±6.62岁（范围22 - 44岁），采用ICEF治疗开放性III级C型股骨远端骨折。其中C1型和C3型骨折各7例，C2型骨折11例。通过延长开放伤口，采用微创技术经骨折块间螺钉实现关节复位和加压，然后用ICEF固定骨折。评估的主要结果包括骨愈合、活动范围、最终短缩、膝关节协会评分以及用于影像学和功能结果的ASAMI评分系统。
平均随访期为19.12±1.14个月。除2例骨折外，所有骨折均在平均30±3.02周时愈合，无需植骨。根据ASAMI评分进行的骨评估，优8例（33.33%），良9例（37.5%），可5例（20.83%），临床最终结果差2例。功能结果优6例（2�%），良9例（37.5%），可6例（25%），差3例（12.5%）。并发症包括短缩、伸直滞后和针道感染。
鉴于取得了令人鼓舞的结果，对于III级开放性粉碎性股骨远端骨折，将ICEF与有限内固定作为主要确定性治疗方法使用是一种有价值的替代方案。
