Fractures of the Distal Femur managed with Less Invasive Skeletal Stabilization System [LISS] using Locking Compression Plate [LCP]: A Study of 20 cases

Balamurugan, P (2008) Fractures of the Distal Femur managed with Less Invasive Skeletal Stabilization System [LISS] using Locking Compression Plate [LCP]: A Study of 20 cases. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Increased incidence of Road Traffic Accidents, natural disasters, industrial accidents claim most of human mortality and morbidity. Hence, it forms the major epidemic of Modern Era. Of these, fractures of distal femur have historically been difficult to treat. In this modern era of increasing life expectancy, there is a rise of old age population which, increases the incidence of these fractures in osteoporotic bones, adding to the morbidity. Because of the proximity of these fractures to the knee joint, regaining full knee motion and function may be difficult. Soft tissue damage, comminution, fracture extension into the knee joint and associated injury to the quadriceps mechanism lead to unsatisfactory results in many cases regardless of the treatment modality. A recent advance in technology for the treatment of distal femoral fractures include the less invasive skeletal stabilization system (LISS) and the locking compression Condylar plates (LCP). They offer multiple points of fixed angle contact between the plate and screws in distal femur (Angle stable construct), reducing the tendency for varus collapse and at the same time afford better stability. The successful management of these injuries, demands thorough knowledge of fracture personality, technical aspects of fracture fixation and the tailored post operative management. AIM OF STUDY: 1. To discuss the role of less invasive skeletal stabilization system using locking compression plate in the management of fractures of distal femur. 2. To discuss the biomechanical advantages of LCP. 3. To discuss the biological advantages of LISS. 4. To evaluate the results of the cases managed by LISS USING LCP. 5. To study the post operative management & the functional outcome after Less Invasive Skeletal Stabilization with Locking Compression Plate for fractures of distal femur. MATERIALS AND METHODS: This is a prospective study of 20 cases of fractures of distal femur in adults treated by Less Invasive Skeletal Stabilization System (LISS) using Locking Compression Plate (LCP). The period of surgery and follow up extends from November 2005 to November 2007. It includes all grades of supracondylar and intercondylar fractures. Pathological fractures and fractures in children were excluded. The case were analysed as per the following criteria. 1. Age distribution, 2. Sex distribution, 3. Side of injury, 4. Mode of injury, 5. Anatomy of injury, 6. Grading of injury, 7. Subtype of fracture, 8. Associated injuries, 9. Open fractures. The age groups varied from 19 years to 70 years with the mean age of 48 years. Incidence of fracture was observed maximum between 40 – 60 years of age. Among the 20 cases, males were predominant with female to male ratio being 1:4 RESULTS: Average healing of the fractures was 12.1 weeks. In compound fractures it was delayed to an average of about 14.5 weeks. The malalignment was less than 7 degrees (varus, valgus). All the patients had good articular alignment. None had a step > 2mm or more the average knee flexion in our series was 90o ranging from 15°-1300, the knee flexion varied according to the subtype of the fracture. Shortening less than 1 cm was recorded in 8 cases and shortening of 7 cm was recorded in one case. All the patients remained painless in the post operative period, except for 3 cases which had wound infection. Functionally all the patients discarded walking aid by 16 weeks and one patient was using heel and sole rise. CONCLUSION: The conclusions of this study are - Fractures of distal femur are more common in high velocity injuries and occur in middle aged men and old age women. Most fractures were comminuted. - Less invasive skeletal stabilization system [LISS] using locking compression plate [LCP], (angle stable construct) with proper physiotherapy produced excellent results. - Locking compression plate [LCP] appears to be technically an ideal implant for comminuted and osteoporotic bones. Infection, knee stiffness and malalignment of fractures were the common complication we encountered in our series which could be tackled by surgical expertise, meticulous soft tissue handling, judicious use of antibiotics and vigorous early knee mobilization. In conclusion less invasive skeletal stabilization system [LISS] using locking compression plate [LCP] produces better results and appears to be a good method of choice for management of fractures of distal femur.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Fractures ; Distal Femur ; Less Invasive Skeletal Stabilization System [LISS] ; Locking Compression Plate [LCP] ; Case study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 15:20
Last Modified: 17 Sep 2017 03:10
URI: http://repository-tnmgrmu.ac.in/id/eprint/2936

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