INTRODUCTION: Fractures of the distal femur are severe injuries that result in varying degrees of permanent disability. As the number of highways become more and high speed driving increases, the potential for devastating injuries like open fractures of the femur with polytrauma also increase substantially. These injuries present with varied combination of bony and soft tissue loss. Bony injury could range from a simple supracondylar fracture pattern to a severely comminuted injury with intraarticular extension and bone loss. There is further understandable reluctance on the part of most Orthopaedic surgeons to primarily use bone graft for open injuries with bone loss.With changing expectations and rise in high velocity injuries, fracture fixation and rehabilitation in open distal femur fracture injuries however is still a challenge.
AIM:
The aim of the study is to analyze prospectively the results of outcomes of various methods of management of Compound Supracondylar fractures of femur.
OBJECTIVES:
To evaluate the result of open Supracondylar fractures of femur in terms of, union, infection, range of motion of knee, complications and need for bone grafting. This study also tries to bring insight into the unpublished area of literature to highlight the importance of need for further research in open supracondylar fractures of femur.
MATERIALS AND METHODS: This is a prospective study of 20 patients with open supracondylar and distal femoral fractures treated with rigid internal fixation using locking compression plate,dynamic condylar screw fixation and knee spanning external fixator and minimal internal fixation with cancellous screws and k wires at Institute of Orthopaedics and Traumatology,Madras Medical College & Government General Hospital, Chennai from May 2008 to September 2010. The patients were selected based on the inclusion and exclusion criteria as given below: Inclusion Criteria - All patients above 18 years with open supracondylar femur fractures extending upto 15 cm from the articular surface. 1. Compound grade I,II,IIIA,IIIB (Gustilo anderson’s classification) of supracondylar fracture of femur. 2. Type A1, A2, A3, B1, B2, B3, and C1,C2,C3 (Muller’s Classification), 3. reporting within 12 hours after Injury. Exclusion Criteria - 1. Associated Multiple Comorbid Conditions, 2. Associated Tibial Plateau Fractures, 3. Associated Vascular Injuries, 4. Pathological Fracture.
RESULTS: 20 cases (four groups) results were studied. Group 1treated with initial wound debridement and followed by either internal fixation with dynamic condylar screw fixation or locking compression plating with an average period of gap between the initial debridement, skeletal traction and definitive fixation was about 3 weeks. Group 2 of patients were treated with initial wound debridement and external fixator with minimal internal fixation for maintaining the articular surface as well as to prevent the flexion of the distal fragment. Group 3 was treated with minimal internal fixation alone. Group 4 was treated with external fixation alone.
CONCLUSION: Though we are able to achieve satisfactory union in compound supracondylar fractures of femur, the functional outcome still remains to be poor in severe (Grade IIIB) cases.
External fixation can only be used as a temporary modality and not as a definitive fixation and we found better results when external fixation was converted early to definitive stable internal fixation. Amount of soft tissue injury correlates with poor results. Grade of compound wound influences more than the fracture pattern in the final outcome. Delay in stable fixation and non compliance to the early Rehabilitation physical therapy also influences the final functional
outcome
