ObjectiveTo investigate the effectiveness of anterior knee incision by the patellar longitudinal approach for osteotomy in treating type C fractures of the distal femur. MethodsBetween March 2010 and June 2014, 36 patients with type C fractures of the distal femur underwent fracture reduction and internal fixation by patellar longitudinal approach for osteotomy. There were 25 males and 11 females, aged 26-72 years (mean, 49 years). Injury causes included traffic accident injury (19 cases), falling injury from height (8 cases), and crushing injury (9 cases). There were 34 cases of closed fracture and 2 cases of open fracture. Associated fractures included 2 cases of patellar fracture and 4 cases of clavicular fracture; combined injuries included 4 cases of anterior cruciate ligament injury, 1 case of posterior cruciate ligament injury, 12 cases of meniscus injury, and 9 cases of medial and lateral collateral ligament injuries. It was 3-11 days from injury to operation (mean, 6 days). ResultsAmong 36 patients, 29 were followed up 12-24 months (mean, 18 months). Primary healing of incision was obtained, without infection or lower limb deep venous thrombosis. X-ray films showed fracture healing at 12-32 weeks (mean, 16.4 weeks). Neither loosening of screw and plate breakage nor valgus and varus knee occurred. Pain and stiff of the knee joint were observed in 4 and 2 cases, respectively; 4 cases walked with a cane. According to Hospital for Special Surgery (HSS) scoring system, the results were excellent in 21 cases, good in 7 cases, and fair in 1 case; and the excellent and good rate was 96.55%. The internal fixation was removed at 10-14 months after operation, and there was no re-fracture. ConclusionThe patellar longitudinal approach has the advantages of sufficient exposure, easy reduction, short operation time, good internal fixation, less damage of soft tissue, and less complication. So it is the appropriate approach to treat type C fractures of the distal femur.
ObjectiveTo review the current status and progress of locking plate for the treatment of distal femoral comminuted fractures.MethodsThe related literature was extensively reviewed to summarize the current status and progress in the treatment of distal femoral comminuted fracture with locking plate from four aspects: the current treatment situation, the shortcomings of locking plate and countermeasures, the progress of locking technology, locking plate and digital orthopedic technology.ResultsTreatment of distal femoral comminuted fractures is challenging. Locking plates, the most commonly used fixation for distal femoral comminuted fractures, still face a high rate of treatment failure. Double plates can improve the mechanical stability of comminuted fractures, but specific quantitative criteria are still lacking for when to choose double plates for fixation. The far cortial locking screw has shown good application value in improving the micro-movement and promoting the growth of callus. The biphasic plating is a development of the traditional locking plate, but needs further clinical examination. As an auxiliary means, digital orthopedic technology shows a good application prospect.ConclusionThe inherent defect of locking plate is a factor that affects the prognosis of distal femoral comminuted fracture. The optimization of locking technology combined with digital orthopedic technology is expected to reduce the failure rate of treatment of distal femoral comminuted fracture.
Objective To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Methods Between July 2007 and December 2009, 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients (new approach group) and by conventional approach in 30 patients (conventional approach group). There was no significant difference in gender, age, cause of injury, affected side, type of fracture, disease duration, complication, or preoperative intervention (P gt; 0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery (HSS) score of knee were recorded. Results Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group (P lt; 0.05). But the intraoperative blood loss and the hospitalization days showed no significant difference between 2 groups (P gt; 0.05). All patients were followed up 12-36 months (mean, 19.8 months). Bone union was shown on X-ray films; the fracture healing time was (12.62 ± 2.34) weeks in the new approach group and was (13.78 ± 1.94) weeks in the conventional approach group, showing no significant difference (t=2.78, P=0.10). The knee HSS score at last follow-up was 94.4 ± 4.2 in the new approach group, and was 89.2 ± 6.0 in the conventional approach group, showing significant difference between 2 groups (t=3.85, P=0.00). Conclusion New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint.
Objective To investigate the efficacy of double-plating fixation via U-shaped incision in the treatment of type C3.3 distal femoral fractures. Methods From July 2006 to February 2009, 11 cases of type C3.3 distal femoral fractures were treated, including 5 open fractures and 6 closed fractures. Among them, there were 7 males and 4 females with an averageage of 43 years (range, 27-55 years). The locations were left side in 6 cases and right side in 5 cases. Fracture was caused by traffic accident in 8 cases and fall ing from height in 3 cases. The time from injury to hospital ization was 30 minutes to 7 days. After bone traction for 3 to 8 days, the operations were performed by double-plating fixation via U-shaped incision, and autograft of il iac bone or allogeneic bone grafting. Results The average time of operation was 128 minutes (range, 105-150 minutes). The average blood loss during operation was 344 mL (range, 290-380 mL). Shallow local skin flap necrosis occurred in 2 cases, and incision healed by first intention in others patients. All patients were followed up 22 months on average (range, 12-36 months). The bone union was achieved within 3-6 months (4.4 months on average). No implant loosening or refracture was found. According to Merchan et al criteria for knee joint function evaluation, the results were excellent in 4 cases, good in 5 cases, fair in 1 case, and poor in 1 case at last follow-up; the excellent and good rate was 81.8%. Conclusion The double-plating fixation via U-shaped incision has the advantages of better exposure, great convenience to manipulation, anatomical reduction, and rigid fixation. It provides an effective treatment for type C3.3 distal femoral fracture. However, its operation indications and operating instructions should be strictly followed.
ObjectiveTo explore the efficacy and advantages of the lower extremity axial distractor assisted closed reduction and retrograde intramedullary nail internal fixation in the treatment of distal femoral fractures.MethodsThe clinical data of 49 patients with distal femoral fractures treated with retrograde intramedullary nail internal fixation between April 2016 and December 2018 were retrospectively analyzed. According to the different methods of intraoperative reduction, the patients were divided into trial group (29 cases, using lower extremity axial distractor to assist closed reduction) and control group (20 cases, using free-hand retraction reduction). There was no significant difference in general information between the two groups (P>0.05), such as gender, age, side of injury, cause of injury, and fracture classification. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, and callus formation time were recorded and compared between the two groups. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation.ResultsAll patients successfully completed the operation. In the control group, there was 1 case with open reduction and internal fixation, and the rest of the two groups were closed reduction. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups (P>0.05). There was no complication such as vascular or nerve injury and iatrogenic fracture, etc. during and after operation, and the incisions healed by first intention. Except for 2 patients in the trial group who were lost to follow-up at 3 months after operation, the rest of the patients were followed up 12-36 months, with an average of 16.0 months. There was no significant difference in the callus formation time between the two groups (t=2.195, P=0.145). During the follow-up, postoperative knee joint stiffness occurred in 1 case in the control group, which improved by strengthening the knee joint function exercise and removing the internal fixator; the rest were not found to be associated with delayed or nonunion fractures, knee stiffness, and internal fixation complication. The function of the affected limb was evaluated according to the Schatzker-Lambert standard at 1 year after operation, the trial group achieved excellent results in 22 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 96.3%; in the control group, the results were excellent in 16 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate was 95.0%; showing no significant difference in the excellent and good rate between the two groups (χ2=0.451, P=0.502).ConclusionThe lower extremity axial distractor assisted closed reduction and retrograde intramedullary nailing for the treatment of distal femoral fractures is convenient, which has satisfactory efficacy.
Objective To investigate current status and latest progress of clinical research on distal femoral fractures. Methods The related literature was extensively reviewed to summarize the trend of the researches and their clinical application in the treatment of distal femoral fractures. Results Distal femoral fractures are likely to occur in young people who suffer from high-energy damage and the elderly with osteoporosis, which is always comminuted and unstable fractures, and often involved in the articular surface and combined with serious soft tissue injury. Therefore, the treatment faces many challenges. External fixation is now used as a temporary means of controlling injury. The vast majority of patients are feasible to internal fixation, including plates system and intramedullary nail system. Different internal fixator also has its own characteristics, such as double plates can strengthen the medial support of the femur, less invasive stabilization system protects the blood supply of fractures, distal cortial locking plate is theoretically more fit for the requirements of bone healing, retrograde intramedullary nail can resist varus and valgus. Conclusion The treatment of distal femoral fractures should be based on the type of fracture and the characteristics of internal fixators.
目的:探讨股骨髁解剖钢板、L钢板及DCS在治疗股骨远端骨折中的应用价值。方法:采用股骨髁解剖钢板内固定治疗股骨远端骨折26例,L钢板内固定治疗股骨远端骨折32例, DCS内固定治疗股骨远端骨折21例。结果:79例经3～15月随访,其中采用解剖钢板26例中23例疗效满意,优良率为885％。采用L钢板32例中23例疗效满意,优良率为719％采用DCS 21例中17例疗效满意,优良率为809％。结论:解剖钢板内固定是治疗股骨远端骨折较为有效的方法,是预防膝关节并发症的积极措施。
Objective To analyze the effectiveness of flexible internal fixation with locking plate for distal femoral fractures. Methods Between January 2015 and June 2016, 21 cases of distal femoral fractures were treated. There were 5 males and 16 females with an average age of 62 years (range, 32-88 years). Injury was caused by falling in 14 cases, by traffic accident in 5 cases, and by falling from height in 2 cases. The fractures located at the left side in 13 cases and the right side in 8 cases. Twenty cases were fresh closed fractures and 1 case was open fracture. According to AO/Association for the Study of Internal Fixation (AO/OTA) typing, there were 5 cases of type 33-A1, 3 of type 33-A2, 8 of type 33-A3, 2 of type 33-C2, and 3 of type 33-C3. The time from injury to operation was 3-13 days (mean, 6.5 days). Results All operation incisions healed primarily. Eighteen patients were followed up 12-24 months (mean, 16 months). All fractures healed, and the healing time was 8-24 weeks (mean, 16.6 weeks). The articular surface was smooth and the thigh length was recovered. No screw loosening, plate breakage, valgus or varus of the knee, stiff of the knee or non-unions occurred during follow-up. There was no significant difference in visual analogue scale (VAS) score between at 6 and 12 months after operation (P>0.05), and the difference was significant bewteen the other time points (P<0.05). There were significant differences in the range of motion of knee between 1 month and 3, 6, 12 months (P<0.05); there was no significant difference between 3, 6, and 12 months (P>0.05). There were significant differences in the Neer scores between 1, 3, 6, and 12 months after operation (P<0.05). According to Neer score criteria, the results were excellent in 12 cases and good in 6 cases at 12 months after operation. Conclusion Flexible internal fixation with locking plate for distal femoral fractures can get good functional recovery.