A Prospective Analysis of Functional outcome of Displaced Distal Femoral Fractures Internally Fixed using Locking Compression Condylar Plates

INTRODUCTION: Fractures of the distal femur are complex injuries. They can produce significant long term disability. They account for 7% of all femoral fractures. If hip fractures are excluded, 31% of femoral fractures involve distal portion. Coronal plane fractures and extensively comminuted fractures preclude the use of commonly used devices like 95° Condylar blade plate, the Dynamic condylar screw with 95° side plate and supracondylar nails. Lateral buttress or neutralization plate may be used, but when this device is applied in presence of medial comminution or bone loss, failure of fixation and varus collapse may eventually result. Recent advances in technology for the treatment of distal femoral fractures include the less invasive stabilization system (LISS) and the locking compression Condylar plates. They offer multiple points of fixed angle contact between the plate and screws in distal femur, reducing the tendency for varus collapse and at the same time afford better stability . AIM OF THE STUDY: The aim of the study is to “Prospectively analyse the functional outcome of displaced distal femoral fractures, internally fixed using locking compression condylar plates” at the department of Orthopaedics and Traumatology, Government Royapettah Hospital, Government Kilpauk Medical College, Chennai between May 2005 and September 2007. MATERIALS AND METHODS: This prospective study is an analysis of functional outcome of 20 cases of displaced distal femoral fractures, internally fixed using locking compression condylar plates, which was undertaken at the department of orthopaedics and traumatology at Government Royapettah Hospital, Chennai from May 2005 to September 2007. The Government Royapettah Hospital, is a multispeciality tertiary care referral and trauma centre with an average bed strength of about 700 and 110 beds allotted for orthopaedics and is situated in the heart of the city. We have a 24 hours emergency casualty, running all 365 days a year and fully equipped to tackle both medical and surgical emergencies, with an emergency operation theatre. RESULTS: All patients were followed at regular intervals (ie., once in a month for the first 3 months and once every 3 months thereafter). The minimum follow up period was 3 months and the maximum followup was 20 months. The mean followup period in this study was 8.46 months. The results were evaluated by taking into consideration the following factors: 1. Pain, 2. Function, 3. Motion, 4. Work, 5. Gross Anatomy and 6. Roentgenograms NEER’S FUNCTIONAL SCORING was used to assess the outcome of surgery, for adult distal femoral fractures1,3.It consists of : Functional (70 units) and Anatomic (30 units) CONCLUSION: The LCP condylar plate is a valuable addition in the armamentarium of the orthopaedician in the management of comminuted distal femoral fractures, with questionable bone integrity. It may not completely solve the age old problems associated with any fracture like non union and malunion, but is a valuable technique in management of these fractures. This technique is not bereft of complications like plate or screw breakage, but careful selection of patients and strict adherence to the basic principles of fracture fixation will go a long way in reducing the complications of fracture fixation using locking compression plates