To Assess Functional Outcome for Intra-Articular and Extra-Articular Distal Femur Fracture in Patients using Retrograde Nailing or Locked Compression Plating

Abstract

Introduction: Distal femur fractures are one of the most common fractures encountered in high velocity trauma which are associated with high morbidity and mortality. The incidence of distal femoral fractures is approximately 37 per 100000 person per year. Fixation of intra-articular fractures is a challenge even to most experienced surgeons. The ideal treatment plan of intra-articular distal femur fracture is still open for debate. Aim: The aim of the present study was to determine the best functional outcome for distal third femur fracture treated by closed/open reduction using retrograde nailing or locked compression plating in respect to knee-flexion, early mobilisation and fracture union. Materials and Methods: A prospective study was carried out at KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, Karnataka, India, in which 40 patients with age > 18 years were operated with either Retrograde nailing (20) or locked compression plating (20) for intra-articular and extra-articular distal femur fractures (July 2015 to June 2017). Patients with Grade 1 and 2 fractures (Gustillo-Anderson classification), who were medically fit, both males and females in the age group of 18 years and above were included in the study. Exclusion criteria included, patients having pathological fractures, who were not fit for surgery, was not willing for surgery, lost in follow up and distal femoral fractures with neurovascular compromise. We use chi-square test and fisher's exact test to find the p-value. Results: Patients who underwent retrograde nailing, showed average radiological union time of 14.6 weeks, average full weight bearing time of 12.4 weeks, average knee flexion of 113.4 degree with an extensor lag of 3 degree. Patients who underwent locked compression plating showed average radiological union time of 16.2 weeks, average full weight bearing time of 14.4 weeks, average knee flexion 106.3 degree with an extensor lag of 4.5 degree. According to Modified Neer's criteria 70% excellent results were found in Retrograde nailing and 65% excellent results were found in Locked compression plating. Conclusion: Retrograde nailing is a good fixation system for fractures of distal femur with better outcome in terms of range of movements, early mobilisation, less operative time and blood loss.