Distal femur fractures: weight bearing and alternative constructs

The geriatric population in general and specifically recipients of total knee arthroplasty (TKA) have increasing functional demands along with an increasing life expectancy. Certain intraoperative aspects of the index procedure, revision TKA, or the patient’s physiology (i.e.- osteoporosis, rheumatoid arthritis, neurologic disease) predispose the patient to post-operative periprosthetic distal femur fractures (PDFF). This review describes the epidemiology, classification, examination, and treatment options of PDFF. Osteoporosis and intraoperative anterior femoral cortex notching are primary patient and surgeon specific factors, respectively. The two most commonly used classification systems were described by Rorabeck and Kim and should be used to guide the surgeon’s choice of treatment. The non-operative treatment of PDFF is rare, requires close radiographic follow up, and delayed union is common. Open reduction with internal fixation (ORIF) is best accomplished with minimally invasive techniques and distal locking screws. Retrograde, intra-medullary nail fixation is technically difficult, but provides earlier weight bearing and comparable time to union as ORIF. Revision TKA is indicated in patients with adequate bone stock, a simple fracture pattern without ligamentous instability, and a loose or malaligned femoral component. Allograft-prosthetic composite (APC) or distal femoral replacement (DFR) is indicated for patients presenting with a PDFF about poor or deficient bone stock. Patients with PDFF present a challenge to the arthroplasty surgeon in regards to choice of treatment and increased morbidity and mortality post-operatively. Close follow up is required and fracture union is often delayed.

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Management of Complex Distal Femur Fractures: Comparative Study between Ilizarov External Fixation and Double Plating

QJM ◽

10.1093/qjmed/hcaa059.007 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

M F Thakeb ◽

A H Gooda ◽

T A Fayyad ◽

M A Elkersh ◽

E N Abourisha

Keyword(s):

Knee Society Score ◽

Distal Femur ◽

Weight Bearing ◽

Femoral Fractures ◽

Controlled Study ◽

Level Of Evidence ◽

Femur Fractures ◽

Randomized Clinical Study ◽

Significant Difference ◽

Double Plating

Abstract Background In this prospective randomized clinical study, we report results of management of type C2 and C3 distal femur fractures by Ilizarov external fixator in comparison with double plating through separate medial and lateral approaches with a mean of 42.8 ± 6.84 weeks follow-up. Patients and Methods In this study we managed 30 cases with highly comminuted distal femoral fractures AO classification type C2 or C3. Fifteen cases were surgically managed by Ilizarov technique and the other fifteen cases were surgically managed by double plating technique. We compare between both group as regard clinical, radiological results and rate of complications. Results while using Knee society score, the results are the following: In Ilizarov group: 7 cases (46.67%) are excellent, 4 cases (26.67%) are good, 3 cases (20.00%) had fair results while 1 case (6.67%) had poor results. In internal fixation group, 8 cases (53.33%) had excellent results, 3cases (20%) had good results, 2 cases (13.33%) had fair results while 2 cases (13.33%) had poor results. Conclusion In fixation of complex distal femur fracture, both Ilizarov and double plating methods had no significant difference in clinical outcome by knee society score and in rate of complications. Ilizarov allow earlier weight bearing and less blood loss while double plating gives better ROM of knee joint and rapid radiological healing. Level of Evidence Level I Randomized controlled study.

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Surgical Treatment of Distal Femur Fractures in Geriatric Patients

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319860723 ◽

2019 ◽

Vol 10 ◽

pp. 215145931986072 ◽

Cited By ~ 1

Author(s):

Antonia Loosen ◽

Yannick Fritz ◽

Michael Dietrich

Keyword(s):

Geriatric Patients ◽

Distal Femur ◽

Weight Bearing ◽

Case Series ◽

Functional Results ◽

Morbidity And Mortality ◽

Locking Plates ◽

Reliable Technique ◽

Perioperative Morbidity ◽

Femur Fractures

Introduction: The treatment of distal femur fractures in geriatric patients is challenging and has a high perioperative morbidity and mortality. Treatments have evolved significantly in the past decades. The aim of our study was to analyze local and systemic morbidity and mortality, as well as functional results in this frail cohort treated with distal femur locking plates. Materials and methods: In this single-institution case series, we retrospectively analyzed the data of patients aged 65 years and older with fractures of the distal femur between March 2013 and March 2018. All patients were operated with distal femur locking plates. Points of interest included perioperative morbidity, mortality, weight-bearing status, and care-dependency after hospital discharge. Results: We assessed 49 patients (median age: 86.5 years) with 52 distal femur fractures (AO type A 77%, type C 15%, type B 8%). A total of 30 (58%) periprosthetic fractures with 4 (8%) interimplant femur fractures were documented. The perioperative morbidity was 64%, and the 3-month and 1-year mortality rates were 29% and 35%, respectively. The local complication rate was 6% with no documented implant failure. Of the patients who were living at home before the surgery, 62% required long-term accommodation in residential or nursing homes after dicharge from the hospital or short-term rehabilitation. Conclusions: Geriatric patients with distal femur fractures face a high perioperative mortality. Osteosynthesis with distal femur locking plates is a reliable technique that can be used in various fracture patterns including periprosthetic and interimplant fractures.

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A clinical study of surgical management of distal femur fracture using locking compression plate

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20193132 ◽

2019 ◽

Vol 5 (5) ◽

pp. 787

Author(s):

A. Varun Kumar Reddy ◽

S. Srikanth ◽

Gudapati Omkarnath

Keyword(s):

Clinical Outcome ◽

Traffic Accidents ◽

Distal Femur ◽

Road Traffic ◽

Weight Bearing ◽

Early Weight Bearing ◽

Non Union ◽

Femur Fractures ◽

Locking Compression Plates ◽

Fall From Height

Background: Fractures of distal femur are common due to increased road traffic accidents and fall from height because of increased construction activities. These fractures are quite disabling hence, these fractures necessitate early stabilization of fractures. Internal fixation with LCP has shown to give one of the best results in terms of recovery, fracture union, and clinical outcome. The aim of the study the clinical outcome of treatment of distal femur fractures using locking compression plates.Methods: A total of n=20 cases of distal femur fractures treated with LCP from December 2013 to June 2015 at NMCH and RC, Raichur. They were admitted and examined according to protocol clinically and radiologically. All patients were followed up for a minimum of 6 months and outcome assessed with Neer’s score.Results: All fractures healed with an average duration of 16 weeks which is comparable with other studies. We had two cases of varus collapse one was due to early weight bearing in one case and other case is due to gross communition. One case had an implant failure (plate breakage) due to early weight bearing. Cases needing hardware revision is comparable to other studies at 10%. Average Neer's knee score was 76.Conclusions: we have found higher Neer’s scores in this study. The LCP also prevents compression of periosteal vessels. It may not completely solve the age-old problems associated with any fracture like non-union and malunion, but is a valuable technique in the management of these fractures. But however, in type C fractures the outcome is poorer.

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Immediate Full Weight-Bearing Versus Partial Weight-Bearing After Plate Fixation of Distal Femur Fractures in Elderly Patients. A Randomized Controlled Trial

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211055889 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110558

Author(s):

Martin Paulsson ◽

Carl Ekholm ◽

Eythor Jonsson ◽

Mats Geijer ◽

Ola Rolfson

Keyword(s):

Elderly Patients ◽

Distal Femur ◽

Plate Fixation ◽

Weight Bearing ◽

Full Weight Bearing ◽

Partial Weight Bearing ◽

Femur Fractures ◽

Function Index ◽

The Mean ◽

Partial Weight

Introduction After surgery for distal femur fractures in elderly patients, weight-bearing is commonly restricted. Immediate non-restrictive weight-bearing might have beneficial effects. There are no randomized studies on the topic. The purpose of this study was to compare the functional outcome between immediate full weight-bearing (FWB) as tolerated and partial weight-bearing (PWB) during the first 8 weeks following plate fixation of distal femur fractures in elderly patients. Methods Patients aged 65 years or older with distal femur fractures of AO/OTA types 33 A2, A3, B1, B2, C1, and C2 were included. Exclusion criteria were impaired cognitive function, concomitant injuries, or inability to follow the postoperative regimen. Internal fixation was achieved with an anatomical lateral distal femur plate applied as a strictly bridge-plating construct. The primary outcome measure was the function index of the short musculoskeletal functional assessment (SMFA) after 52 weeks from injury. Results Thirty-two patients were randomized to FWB (n = 11) or PWB (n = 21). After 16 and 52 weeks, there were no differences in the mean SMFA function index between FWB and PWB (36 vs 43, P = .42 and 52 vs 40, P = .18, respectively) nor in the mean EuroQol 5-dimension index or range of motion (ROM). Overall, the SMFA function index was higher at 52 weeks compared with before injury (44 vs 30, P = .001) as was the mean bothersome index (37 vs 21, P = .011). There was no clear difference in the occurrence of adverse events between the treatment groups. Conclusions There were no differences in functional outcome, adverse events, or ROM between immediate FWB and PWB following plate fixation for a distal femur fracture in elderly patients. A distal femur fracture has a negative effect on the functional status of elderly patients that persists at least up to 1 year following injury.

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182 Treating Distal Femur Fractures Without Fluoroscopy: Comparison of Implants Used in a Rural Hospital in Tanzania

British Journal of Surgery ◽

10.1093/bjs/znab135.042 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J Allen ◽

S Kiewsa

Keyword(s):

Distal Femur ◽

Weight Bearing ◽

Exclusion Criteria ◽

Delayed Treatment ◽

Femur Fractures ◽

Open Injury ◽

Antegrade Approach ◽

Time From Injury ◽

Larger Sample

Abstract Introduction SIGN is a charity providing implants for hospitals with limited resources. There are two nails that can be inserted without fluoroscopy - the standard SIGN nail and the Fin nail. We aimed to evaluate the effectiveness of these implants in treating distal femur fractures. Method Retrospective analysis of SIGN database at Nkoaranga Hospital, Tanzania between July 2017 and January 2019. 28 patients (20 male, 8 female) with distal femur fractures had a standard nail (n = 14) or a Fin nail (n = 14). Inclusion criteria: distal femur fractures treated with intramedullary nail. Exclusion criteria: age<16, open injury, antegrade approach, no follow-up at 4 weeks. Results Mean age was 41.4 (18-81). Average time from injury to surgery was 29 days. Average first follow-up was 14 weeks (4-73). Painless weight-bearing was achieved in 93% (13/14) of standard nails and 100% (14/14) of Fin nails. Knee flexion >30° was 64% (9/14) in standard nails and 50% (7/14) in Fin nails. Screw loosening was seen in 7% (1/14) in standard nails and no patients with Fin nails. There were no instances of implant breakage, clinical deformity, or infection. Conclusions Patients had variable follow-up and presented late causing delayed treatment. Both nails can achieve excellent results. A larger sample size is required.

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Early versus delayed weight bearing after surgical fixation of distal femur fractures: a non-randomized comparative study

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-019-02486-4 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1789-1794 ◽

Cited By ~ 6

Author(s):

Paolo Consigliere ◽

Efthymios Iliopoulos ◽

Tamer Ads ◽

Alex Trompeter

Keyword(s):

Comparative Study ◽

Distal Femur ◽

Weight Bearing ◽

Femur Fractures ◽

Surgical Fixation

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Is Immediate Weight-Bearing Safe After Single Implant Fixation of Elderly Distal Femur Fractures?

Journal of Orthopaedic Trauma ◽

10.1097/bot.0000000000001882 ◽

2021 ◽

Vol 35 (1) ◽

pp. 49-55

Author(s):

Charles M. Lieder ◽

Greg E. Gaski ◽

Walter W. Virkus ◽

Laurence B. Kempton

Keyword(s):

Distal Femur ◽

Weight Bearing ◽

Implant Fixation ◽

Femur Fractures ◽

Single Implant

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Locking condylar plate: best device to treat supracondylar fractures of the femur

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20190966 ◽

2019 ◽

Vol 5 (3) ◽

pp. 393

Author(s):

Irwant V. Pallewad ◽

Vijay B. Kagne ◽

Jayshree J. Upadhye

Keyword(s):

Fracture Fixation ◽

Distal Femur ◽

Road Traffic ◽

Weight Bearing ◽

Femoral Fractures ◽

Research Centre ◽

Full Weight Bearing ◽

Supracondylar Fractures ◽

Femur Fractures ◽

Fractures Of The Femur

Background: Supracondylar fractures of the femur in adults account for only 7% of all femoral fractures. However, these fractures present with numerous complications. The purpose of this study was to assess the outcome of locking condylar plate in supracondylar fractures of femur in adults.Methods: This study was based on 25 patients of supracondylar fracture of the femur treated with locking condylar plate at Srinivas Institute of Medical Sciences and Research Centre, Mukka, Suratkal, Mangalore. The patients were followed up for 1 year.Results: In present study, 84% fractures were sustained due to road traffic accidents. In 23 (92%) patients, full weight bearing was achieved at 20 weeks while only 2 (8%) patients required more than 20 weeks. 80% of cases required less than 16 weeks for union while 20% required more than 16 weeks. Average injury to surgery time was 3.62 days in the present series. Superficial stitch infection occurred in two cases. Deep infection occurred in a grade 2 compound fracture in a male who was treated initially with debridement and antibiotics.Conclusions: Good results are seen by distal femur locking condylar plate alone. It is the main implant of choice for distal femur fractures of all varieties. Best outcome is expected if fracture fixation is done following all the basic principles of fracture fixation. Advantage of the mechanical properties of a locking plate is definitely useful.

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Minimally invasive plate osteosynthesis of lower end of femur fractures using locking compression plating: a prospective study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20173939 ◽

2017 ◽

Vol 3 (5) ◽

pp. 1043 ◽

Cited By ~ 1

Author(s):

Raghu Kumar J. ◽

Prasanna Anaberu ◽

Vinit M. Oswal

Keyword(s):

Minimally Invasive ◽

Internal Fixation ◽

Closed Reduction ◽

Distal Femur ◽

Tissue Injury ◽

Plate Osteosynthesis ◽

Weight Bearing ◽

Soft Tissue Injury ◽

Minimally Invasive Plate Osteosynthesis ◽

Femur Fractures

Background: The treatment of distal femur fractures has recently evolved towards indirect reduction and minimally invasive techniques. The goal is to strike a balance between the mechanical stability of the fragments and the biological viability. Pre-contoured Locking compression plates (LCPs) have shown to give best results in terms of recovery, fracture union, return to work and functional outcome. Advent of MIPO technique has reduced the amount of soft tissue injury, delayed healing, tissue necrosis and infections.The objective was to study the functional result of fracture distal femur treated by closed reduction with LCP by minimally invasive plate osteosynthesis (MIPO).Methods: 20 cases of fracture distal end of femur were treated by closed reduction and internal fixation using LCP by MIPO between 1st October 2013 to 30th September 2015 at our centre. The patients were evaluated clinically and radiologically for functional outcomes. All patients were followed up for an average of 12 months. Outcome was assessed using NEER’s score.Results: 8 of my patients were male and 12 were female. All of them were closed injuries and fresh cases. The mean age was 51.8 years (21-68 yrs). 13 patients sustained RTA and 7 patients had accidental fall. 8 patients had right sided distal femur fracture and 12 had left sided injury. According to NEER’s score 50% had excellent results, 35% had good results and 15% had fair results. Gait and weight bearing after union was satisfactory. Range of motion of knee joint in majority of patients was within acceptable limits. Conclusions: Closed reduction and internal fixation of fracture lower end of femur by MIPO using LCP is one of the best modalities of treatment for good results.

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