Management Of Fractures Of Distal Femur - Intra-Articular Type C2 By Locking Plate Or Condylar Buttress Plate
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2016, Vol 2, Issue 2
Abstract
Background:- Intra articular fractures of distal femur is a great surgical challenge when associated with metaphyseal comminution (Type C 2) in terms of getting reduction and difficulty of maintaining reduction. Operative treatment is usually recommended for favorable outcome. These are frequently comminuted and intra-articular due to association with high energy trauma (in the youngsters) and osteoporotic bones (in the elderly). A wide canal, thin cortex and poor bone stock of the distal femur make open reduction in these areas a great challenge. Materials and Methods:- This study was carried out in department of Orthopaedics, Government medical college Latur from December 2009 to November 2015.30 Patients with intra-articular fracture AO TYPE C 2 of distal femur admitted to the hospital were selected as cases. Condylar buttress plate and locking plate were used for 30 patients with distal femur fractures. Patients were followed for a minimum period of two year & relevant data like time to union, knee range of movement and complications were recorded. Results: -According to SCHATZKER AND LAMBERT CRITERIA (for assessing final outcome) Out of 30 patients, A) Locking plate:-10 patients operated with locking plates, 5(50%) had Excellent to Good results, 3 (30%) had Fair result and 2(20%) had Poor results. B) Condylar Buttress plate:-Out of 20 patients operated with condylar buttress plate 12 (60.00%)hadExcellent to Good result , 3 (15.00%) has Fair and 05 (25%) had Poor results. Conclusion:- Type C2 fractures with severe metaphyseal comminution, when fixed with Condylar buttress plate has great advantage in fixation of distal femur fractures as it allows and gives the freedom to place the screws at different directions in multiple planes so as to engage and fix fracture fragments located at different positions. In addition it can be used in all types of distal femur fractures and it is cheap as compared to other implants. Locking plates are very useful when there is severe osteoporosis with less bone stock and gross comminution of fracture fragments. Shortcoming of locking plate is- It does not allow to pass screws in different directions (Cf. Condylar buttress plate), so as to engage different fracture fragment at different planes. Also, locking plate is costlier as compared to condylar buttress plate. Meticulous reduction of distal articular surface is key to the success of management of these fractures; hence primary realignment is essential for definitive fixation. Medial plating is not always required for medial column comminuted fractures.Good bony contact of all comminuted fragments is very essential for good fracture union which eliminated need of bone grafting in our study.
Authors and Affiliations
Satish R Gawali, Pramod V Niravane, Raman O Toshniwal, Sachin M Kamble
Keywords
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