Prospective Analysis of Retrograde Supracondylar Nailing in the Management of Supracondylar and Distal Femoral Fractures

Hementha Kumar, G (2007) Prospective Analysis of Retrograde Supracondylar Nailing in the Management of Supracondylar and Distal Femoral Fractures. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Fractures of the Distal femur are complex injuries that pose a challenge to the orthopaedic surgeon. It constitutes about 6 % of all femoral fractures. It usually occurs during high energy trauma in younger patients and frequently are associated with concomitant injuries. In contrast, elderly patients with severe osteopenia might sustain solitary distal femoral fractures from minor trauma such as a simple fall. AIM: The aim of the study is to analyse prospectively the results of Retrograde Supracondylar Intramedullary Nail in the management of Distal femoral and Supracondylar Fractures. MATERIALS AND METHODS: This is a prospective study of 20 patients with supracondylar and distal femoral fractures treated with Retrograde Supracondylar nail at Government General Hospital , Chennai from June 2005 to September 2006. The patients were selected based on the inclusion and exclusion criteria as given below. Inclusion Criteria - All patients above 18 years with closed & grade I & II open fractures of supracondylar & distal femur fractures extending up to 15 cm from distal articular surface. Fractures Include 1. Closed distal femoral fractures & non-union. 2. AO type A1 A2 & A3 fractures. 3. AO type C1 C2 fractures. Exclusion Criteria - 1. AO type B1 B2 & B3 fractures. 2. AO type C3 fractures. 3. Grade III open fractures. RESULTS: In our study, 20 cases were treated by retrograde intramedullary supracondylar nail. Patients were followed up every 3 weeks till fracture united and there after at 3 months, 5 months and 1 year. The minimum follow up period in our study was 4 months and maximum follow up period was 14 months.One of them had expired one month following surgery due to septicaemia secondary to pressure sores and not directly attributable to the operative procedure. Clinically, tenderness at fracture site, knee pain, limb length discrepancy, range of movements, any varus or valgus deformity were assessed at each follow up. The results were analyzed with standard anteroposterior and lateral radiographs. Clinical and radiological signs of union were analysed at each follow up. The fracture was said to be radiologically united if callus was seen in at least 3 cortices in anteroposterior and lateral views. The functional outcomes were analysed using KNEE RATING SYSTEM BY THE HOSPITAL FOR SPECIAL SURGERY. CONCLUSION: Distal femoral fracture poses a challenging problem to the orthopaedics surgeon as it occurs in young with high velocity and elderly with low velocity trauma. Early internal fixation and mobilization of the patients is of paramount importance. Presence of osteoporotic bone and presence of other injuries around the knee complicate the problem further. Retrograde supracondylar nail has evolved to address some of the problem in fixation of these fractures. It has benefits of less periosteal stripping, reduced blood loss, decreased hospital stay and operating time. Based on our study, we conclude that early surgical intervention and mobilisation of patients will give better results. Moreover, closed method of reduction should be done wherever possible and percutaneous nailing should be advocated to yield better results. We conclude that this technique is easy and adds to armamentarium of every orthopedic surgeon.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Retrograde Supracondylar Nailing ; Management ; Supracondylar ; Distal Femoral Fractures ; Prospective Analysis.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 01:53
Last Modified: 14 Sep 2017 01:53
URI: http://repository-tnmgrmu.ac.in/id/eprint/3074

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