Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation

Vinoth Kumar, N (2015) Comparative analysis of functional outcome of distal femur fractures treated with Locking Compression Plate fixation and Dynamic Condylar Screw fixation. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Fractures affecting the distal femur are very complex injuries that pose a challenge to every orthopedic surgeon. It involves about 7% of all femur fractures. It commonly occurs during high velocity trauma in younger patients and frequently are associated with other skeletal injuries. In contrast to this, elderly patients with osteoporosis might sustain isolated distal femur fractures from trivial trauma. Despite all advanced Technologies and modern diagnostic imaging modalities versatile implants available in market, more difficulties found in internal fixation and maintenance for the fracture. MATERIAL AND METHODS: Our study is short term prospective and retrospective study conducted in Institute of orthopedics and traumatology, Madras medical college, Rajiv Gandhi Govt. General Hospital. Chennai. Tamil Nadu. Patients admitted with distal femur fractures are selected on the basis of inclusion and exclusion criteria. We have followed Muller Classification for distal femur fractures, based on which treatment modalities determined. Adult age group with Type A and C Muller included and Type B and skeletal immature patients and Gr III compound excluded in this study. Our study sample size is 25 patients, of which 10 patients treated with dynamic condylar screw and 15 patients with distal femur locking compression plate. They were processed as per protocol, traction of extremity till the patient get fit for surgery. We have used Extensile Lateral approach to fix the fracture with patient supine with sand bag underneath knee. Fractures treated with either LCP and DCS followed in standard protocol and evaluated in serial follow up. Functional outcome analyzed using standard scoring system called Hospital for Special Surgery. OBSERVATION AND RESULTS. In our study Males are more affected with 80% and age group 40-50 years more commonly involved with 28%. Mode of injury Road traffic accidents in 76% patients and 24% in accidental fall.11 patients got associated injuries. Muller sub type C2, C3 accounts for 40% of patients. Open injuries of type I and II accounts for 20% of all fractures. Distal femur fractures treated with DCS shows 60% excellent and good outcome and 40% shows fair and poor outcome, whereas those treated with LCP shows 66.6% excellent and good results and 33.3% fair and poor results. Overall in our study 64% excellent and good outcome and 36% poor outcome. Muller sub type A fractures both LCP and DCS producing similar results whereas Muller subtype C, LCP shows very good results when compare to DCS. 5 Patients shown complications like superficial wound infection, deep infection. DISCUSSION: Dynamic condylar screw is easy construct with fixed angle of 95o blade plate junction, it has own advantages and disadvantages, it can correct sagittal plane deformity and has good inter fragmentary compression ,relatively easy to insert. It shows very good results in Type A Muller subtype fractures. Demerits of very bulky implant, correcting only medio lateral displacement rather than antero posterior displacement. At least 2.5 to 3 cm bone stock above joint line should be mandatory to insert lag screw and it doesn’t have any control of distal fragment antero posterior rotation and medial varus collapse of the distal fragment. To address all this complications Locking Compression Plate introduced, It has got advantages of rigid and anatomical reduction and stabilization. Since it has got multiple purchases in distal fragment, shown good stability and rotation control in all plane. Locking screw design made this implant of choice in osteoporotic elderly patients. Type C fractures with intra articular extension, LCP shows good results when compare to DCS. In the aspects of Cost of implant, technical limitations made this implant inferior to DCS. CONCLUSION: 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. Locking compression plate [LCP] appears to be technically an ideal implant for comminuted distal femoral fractures with proper physiotherapy produced excellent results, whereas extra articular Type A fractures LCP and DCS shown similar results. However large study group and long follow up needed for accurate functional outcome

Item Type: Thesis (Masters)
Uncontrolled Keywords: Comparative analysis ; functional outcome ; distal femur fractures treatment ; Locking Compression Plate fixation ; Dynamic Condylar Screw fixation.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 25 Sep 2017 01:15
Last Modified: 06 Oct 2018 07:49

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