Shekar Dheeraj D, Meena Ramesh Chand, Sharma Shyoji Lal, Vijayan Krishnapriya T, Nayak Sachin, Singhal Anushrey
Department of Orthopaedics, S.M.S. Medical College, Jaipur, Rajasthan, India.
Department of Obstetrics and Gyanecology, LF Hospital, Angamaly, Kerala, India.
J West Afr Coll Surg. 2023 Jul-Sep;13(3):59-64. doi: 10.4103/jwas.jwas_23_23. Epub 2023 Jun 27.
Unicondylar fracture of distal femur accounts for less than 1% of all femoral fractures. As conservative methods have shown substandard results, traditional surgical treatment includes open reduction and internal fixation by Herbert screws, cannulated screws, and conventional lateral locking plates. Though screw fixation has excellent results over long run, there is literature documenting the loosening and loss of articular congruency in elderly patients and in comminuted fracture patterns. Also, the traditional locking plates are precontoured to fit the lateral condyle, whereas there is no specific implant to fix the medial condylar fractures. The merit of the calcaneal plating is that it is easily moldable and can be used for either of the sides irrespective of fracture pattern.
This study aimed to evaluate the clinical outcome of calcaneal plate (D-shape) fixation in distal femur unicondylar fractures.
A total of 30 patients were studied, who met the inclusion criteria and consented to the surgery. After appropriate investigations, these patients were treated with calcaneal plating and were followed up postoperatively at 2 weeks, 1 month, 3 months, and 6 months for clinical evaluation.
There was a gradual increase in the range of motion (ROM) with subsequent follow-ups. The overall mean ROM evaluated at 6 months was 108.46° ± 28.27° with < 0.001 and was a statistically significant outcome. Also, the mean ROM for sagittal split fractures (120°) was comparatively more than the coronally split fractures (90°). The functional outcome assessed by Neer scoring showed excellent and satisfactory results in 24 (80%) patients, whereas the remaining six (20%) patients had poor results. None of the patients had nonunion, infection, or implant failure.
With no specific implant for isolated unicondylar fractures, the use of calcaneal plate in our study has shown promising results probably due to its low profile design reducing the soft-tissue irritation and wide area of bone coverage by the plate offering regions of intermittent fixation due to its spanning design, thereby promoting periosteal preservation and ultimately fracture union.
股骨远端单髁骨折占所有股骨骨折的比例不到1%。由于保守治疗方法效果不佳，传统手术治疗包括使用Herbert螺钉、空心螺钉和传统外侧锁定钢板进行切开复位内固定。尽管从长远来看螺钉固定效果良好，但有文献记载老年患者和粉碎性骨折类型中存在螺钉松动和关节面一致性丧失的情况。此外，传统锁定钢板是预塑形以适配外侧髁，而没有专门用于固定内侧髁骨折的植入物。跟骨钢板的优点是易于塑形，可用于任何一侧，而不受骨折类型的限制。
本研究旨在评估跟骨钢板（D形）固定治疗股骨远端单髁骨折的临床疗效。
共研究了30例符合纳入标准并同意手术的患者。经过适当检查后，这些患者接受跟骨钢板治疗，并在术后2周、1个月、3个月和6个月进行随访以进行临床评估。
随着后续随访，活动范围（ROM）逐渐增加。6个月时评估的总体平均ROM为108.46°±28.27°，P<0.001，具有统计学意义。此外，矢状面劈裂骨折的平均ROM（约120°）相对高于冠状面劈裂骨折（约90°）。通过Neer评分评估的功能结果显示，24例（80%）患者结果为优或良，其余6例（20%）患者结果较差。所有患者均未发生骨不连、感染或植入物失败。
对于孤立的单髁骨折没有专门的植入物，在我们的研究中使用跟骨钢板显示出了有前景的结果，这可能是由于其外形低矮设计减少了软组织刺激，并且钢板覆盖的骨面积广，其跨越设计提供了间歇性固定区域，从而促进了骨膜保留并最终实现骨折愈合。
