Surgical Treatment for Distal Femoral Fractures - a 2-year Retrospective Study

Cuvinte cheie: fractura femur distal, Tija retrograda, LISS, NCB Abstract: Background: The treatment of distal femoral fractures has been associated with a high rate of complications for a long period of time. Although implant and surgical techniques have improved, plate osteosynthesis and intramedullary nailing have been accompanied by a high rate of infection, non-union and malalignment. The gently manipulation of the soft tissue envelopes by using “biological” osteosynthesis and minimally invasive approaches has resulted in a decrease in complications rates and led to the concept of the less invasive stabilization system (LISS). This is an extramedullary-applied internal fixator (locking plate) shaped according to the local anatomy of the distal femur. One of the limits of this system is the fixed-angle position of the locking screws into the plate. In the last years, the poliaxial locking plates had evolved, over passing the inconvenient of the fixed-angle position of the screws. This type of the screw allows also interfragmentary compression across the plate for intercondylar fractures. The purpose of this study was to review the experience and evolution of our practice from intrammedullary device to polyaxial locking plates, in the last two years (2010 and 2011). Material and method: In a retrospective consecutive study, 21 patients with 22 distal femoral fractures where treated with: S 2 retrograde nail Stryker (2 patients – 9.1%), LISS Synthes (5 patients – 22.7%) or NCB plate Zimmer (14 patients – 15 fractures – 68.2%). We lost 5 patients after 1 month of follo-up. The medium follow-up for the rest of the patients was 6.2 months. Results: We had no deep wound infection (0%). We had 1 fracture (5.9 %) of the proximal end of the plate (solved with a long Gamma nail) and 2 non-unions (11.75%) which consolidated after the treatment (one solved with a vascularised bone graft fibula and one associated with a plate failure, solved with plate changing and bone grafting). From the functional point of view, 11 patients (64.7%) had a knee flexion greater than 110o, 4 patients (23.5%) had a knee flexion between 90o – 110o and 2 patients (11.8%) had a knee flexion between 75o-90o. The average consolidation time for the 14 non-complicated fractures was 16 weeks. Conclusions: The minimally invasive techniques (intramedullar or paracortical) for distal femoral fractures stabilisation promotes early mobilization and rapid rates of bony and clinical healing, without primary bone grafting and very low rate of infection (in our study 0%).