Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen
10.1016/j.cjtee.2019.08.005
- Author:
Maley Deepak KUMAR
1
;
Roop SINGH
1
;
Rakesh KHIYANI
1
;
Kiranpreet KAUR
2
Author Information
1. Department of Orthopaedic Surgery, Paraplegia & Rehabilitation, Pt. B.D. Sharma PGIMS, Haryana, Rohtak 124001, India
2. Department of Anesthesiology and Critical Care, Pt. B.D. Sharma PGIMS, Haryana, Rohtak 124001, India
- Collective Name:Baba Saheb Ambedkar Medical College, Rohini, New Delhi, India
- Publication Type:Journal Article
- Keywords:
Distal femur fracture;
Supracondylar;
Open fractures plating;
Outcome
- From:
Chinese Journal of Traumatology
2019;22(6):328-332
- CountryChina
- Language:English
-
Abstract:
Purpose::Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1% of all fractures. Open fracture takes 5%-10% of the all distal femoral fractures, which is at an increased risk of complications. There were limited studies which documented the outcomes of such cases. The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.
Methods::This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India. Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement. They were followed for minimum of six months. Patients were followed up monthly for first four months, at six months and one year after surgery. Clinical and radiological signs of healing, any complications, time to union, and functional outcome were assessed.
Results::The mean age of patients was 44.33 years (range 20-82 years) with male predominance of 66.7%. According to Gustilo-Anderson classification, there were 5, 15 and 10 patients with open grade I, II and IIIA distal femoral fractures respectively. According to orthopaedic trauma association (OTA) classification, majority of patients in our study were of C3 type. The mean time to bony union was 5.6 months (range 4-9 months). Average postoperative knee range of motion (ROM) at the latest follow-up was 98° (range 70°-120°). Lysholm knee scoring scale showed excellent score in 11 patients, good in 9 patients, fair and poor in 5 patients each; however, there was no significant correlation with fracture pattern types (p < 0.05). Knee stiffness was the major complications encountered in the study. The knee ROM was <90° in 5 patients and 90°-120° in rest of the patients, while 1 patient had extensor lag of 10°. One patient had implant failure and lost to follow-up; 3 patients had deep infection.
Conclusion::An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.
