TO STUDY THE OUTCOME OF FIXATION AND RECONSTRUCTION OF DISTAL FEMORAL (SUPRACONDYLAR) OPEN FRACTURES WITH BONE LOSS USING DISTAL FEMORAL LOCKING PLATES AND AUTOLOGOUS, NON VASCULARIZED FIBULAR STRUT AND CORTICO-CANCELLOUS BONE GRAFTING

Dr Naresh Rana

Abstract


Objectives: To study the outcome of Fixation and  reconstruction of distal femoral (supracondylar)  open Fractures with  bone loss using Distal femoral locking plates and  autologous, non vascularized fibular strut and cortico-cancellous bone grafting.

Introduction: Distal femur fractures are difficult, complex injuries that can result in devastating outcomes. The intra-articular injury can vary from a simple split to extensive comminution. Articular involvement can lead to posttraumatic arthritis. These fractures constitute 4% to 7% of all femur fractures. There is a bimodal distribution defined by the mechanism of injury. They are complex injuries that are difficult to manage; despite advances in technique and improved implants, treatment remains a challenge in many situations.  The goal of any treatment is to maintain or restore the congruity of the articular surface and restore the length and alignment of the femur and subsequently the limb.

Methods and material:

 15 patients(30-35 Years, all Male) involved in high velocity road traffic accident and Fall  who presented to emergency department at Government Medical College Jammu, India,  between June 2018 to June 2019, with open fracture of the distal femur with bone loss (severe bone loss in 11 patients and moderate loss in 4)  were included in the study. All were managed with initial wound debridement and above knee slab/external fixator.  Subsequently fractured femur was reconstructed with distal femoral locking plate stabilization, along with autologous non vascularised fibular Strut graft and cortical-cancellous graft bridging the bone defect. Single free fibular strut was used in all patients  with autologous cortico-cancellous bone grafting in all. Clinical union, radiological union, and knee function were assessed.

Results:

The period of follow up was 12 months. The average duration of hospital stay was 10 days. The time taken for radiological  union in our study ranges from 14 weeks to 19 weeks with a mean of 13.5 weeks. 9 patients  had more than 100° of knee flexion and 6 patients had less than 100 degree. The minimum flexion obtained was 70° and maximum being 120° There were 2 patients with varus angulation of 10 and 15°. Mean limb shortening was  2 cms . No limb shortening was observed in five patients. Patients were pain free and had no significant graft or donor site morbidity. Complication included 1 case of non-union and 1 case of superficial wound infection which subsided with antibiotics. 3 cases with extensor lag with an average of 6°. Functional assessment after union revealed two  patient with excellent knee function, 11 good,  and  two  poor function according to Sanders scoring.

Conclusion: Staged fibular strut grafting and  cortico-cancellous bone grafting  appears to be a good treatment option  for traumatic open supracondylar femoral fractures with significant bone loss.


Keywords


Supracondylar fracture femur, bone loss, free fibular reconstruction; fibular struts; cancellous bone grafting, Sander scoring.

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