Amin T K, Patel I, Patel M J, Kazi M M, Kachhad K, Modi D R
Department of Orthopaedics, Smt NHL Municipal Medical College, Ahmedabad, India.
Malays Orthop J. 2021 Nov;15(3):78-83. doi: 10.5704/MOJ.2111.012.
Fractures of the distal femur account for 0.4% of all fractures. They involve about 7% of all femur fractures, with bimodal age distribution, commonly occur during high-velocity trauma of motor vehicle accidents in the younger group of patients and are frequently associated with other skeletal injuries. The treatment of distal femoral fractures has evolved from conservative treatment to more aggressive operative treatment. The aim is to achieve and maintain a good reduction of the joint to allow early active mobilisation, thus minimising the joint stiffness and severe muscular atrophy encountered in the conservative treatment.
This is a retrospective study of 25 patients with distal femur fracture with intra-articular extension treated with open reduction and internal fixation with DFLP, admitted at our institute between 2016 to 2019, with a minimum follow-up of six months.
In our study, 19 (76%) patients had excellent to good results. Three (12%) patients had fair outcomes, and three (12%) patients had poor outcomes according to Neer's score. The average time for bone union in closed fractures was earlier (4.25 months) than open fractures, averaging 5.86 months. The outcome was almost similar between closed and open fractures. There were 2 (8%) cases of infection in the early post-operative period, 7 (12%) patients suffered from knee stiffness, and there were 3 (12%) cases with a pre-operative bone loss that required bone grafting.
Management of complex intra-articular distal femur fracture has always been a challenge. Anatomical reduction of articular fragments and rigid fixation of these fractures are a must. DFLP provides angular stability with multiple options to secure fixation of both metaphyseal and articular fragments with the restoration of the joint congruity, limb length, alignment and rotation, allowing early mobilisation and aggressive physiotherapy without loss of fixation, resulting in gratifying functional outcome and low complication rate.
股骨远端骨折占所有骨折的0.4%。它们约占所有股骨骨折的7%，具有双峰年龄分布，在年轻患者组中常见于机动车事故的高速创伤期间，并且经常与其他骨骼损伤相关。股骨远端骨折的治疗已从保守治疗发展为更积极的手术治疗。目的是实现并维持关节的良好复位，以便早期进行主动活动，从而将保守治疗中遇到的关节僵硬和严重肌肉萎缩降至最低。
这是一项对2016年至2019年在我院收治的25例采用DFLP切开复位内固定治疗的股骨远端关节内骨折患者的回顾性研究，随访时间至少为6个月。
在我们的研究中，根据Neer评分，19例（76%）患者结果为优至良。3例（12%）患者结果一般，3例（12%）患者结果较差。闭合性骨折的平均骨愈合时间（4.25个月）早于开放性骨折，开放性骨折平均为5.86个月。闭合性骨折和开放性骨折的结果几乎相似。术后早期有2例（8%）感染病例，7例（12%）患者出现膝关节僵硬，3例（12%）术前存在骨丢失病例需要植骨。
复杂的股骨远端关节内骨折的治疗一直是一项挑战。关节面骨折块的解剖复位和这些骨折的坚强固定是必不可少的。DFLP提供角稳定性，有多种选择来确保干骺端和关节面骨折块的固定，同时恢复关节一致性、肢体长度、对线和旋转，允许早期活动和积极的物理治疗而不丢失固定，从而获得满意的功能结果和低并发症发生率。
