Comparative study of management of distal femoral fractures managed by dynamic condylar screw and distal femoral locking compression plate

Background:Distal femoral fractures are much less common than hip fractures and account for 7% of all femoral fractures. Distal femoral fractures are difficult to treat and ideal treatment of such fractures will include anatomical reduction, rigid fixation of articular surfaces and early mobilization of knee joint. Our study aims to compare the outcome of fifty distal femoral fractures which were treated by two different implants i.e dynamic condylar screw and distal femoral locking compression plate. Materials and methods : Fifty consecutive patients were included in the study with minimum follow up of one year, twenty five of them were managed by surgery with dynamic condylar screw, so they were placed in group A i.e DCS group and another twenty five patients were managed by surgery with distal femoral locking compression plate hence placed in group B i.e DFLCP group. The assessment of result was done with criteria laid down by Schatzker and Lambert which was based on the union of fractures, amount of range of motion of knee joint and by assessing the complications of each implant Results: In the present study, in both the DCS and DFLCP groups showed 76% of patients with good or excellent results. Based on type of fracture,for Type-A fractures, in DCS group total of 91% patients had good to excellent results, whereas in DFLCP group, total of 80% patients showed good to excellent results. For Type-B fractures, in both DCS and DFLCP group total of 80% of cases had good to excellent results. For Type-C fractures, under DCS group, 55% cases had good to excellent results and in DFLCP group 70% patients had good to excellent results. Conclusion It was concluded that dynamic condylar screw and distal femoral locking plate have similar results except that distal femoral locking plate is better in comminuted distal fractures. Introduction Fractures of the distal femur whether supracondylar or intercondylar have been historically difficult to treat because of their unstable nature and degree of comminution. The proximity of these fractures to knee joint further makes full range of motion and function difficult. The incidence of malunion, nonunion, and infection is also high (Chiron et al., 1974). Distal femoral fractures are much less common than hip fractures and account for 7% of all femoral fractures. Anatomical reduction of the articular surface, restoration of limb alingement, and early mobilization have shown to be effective ways of managing most distal femoral fractures. Despite the advances in techniques and the improvement in surgical implants, treatment of distal femoral fractures remained a challenge. Long term disability can occur in patients with extensive articular cartilage damage, marked bone comminution and severe soft tissue injury (Schatzker et al., 1998). Osteoarthritis may occur if intra-articular step is 3 mm or more. The various methods used earlier for stabilization of distal femoral fractures were:Closed reduction and casting, Skeletal traction alone, Angled blade plate (Schatzker et al., 1979),Rush rods ,Enders nail, GSH (Green Seligson Henry) nail and Zickle device. However all these devices were technically demanding and did not achieve rigid fixation of articular surface and good purchase of osteopenic bone. Complications of distal femoral fractures include malunion, non union, varus angulation, limb length discrepancy, infections, and secondary osteoarthritis of patella-femoral and tibio-femoral joints. Implant failure, periprosthetic fractures and the disruption of fixation can also occur with any device used for internal fixation especially in comminuted varieties and in elderly because of osteoporosis. The Dynamic condylar screw is an impressive mode of treatment with advantages of early and good range of motion, stable internal fixation and maintenance of anatomical reduction but the main disadvantage is that it can only be used when atleast 4 cms of area above the inter-condylar notch is uncomminuted. The distal femoral-locking compression plate which is WebmedCentral > Research articles Page 3 of 14 WMC004976 Downloaded from http://www.webmedcentral.com on 15-Sep-2015, 01:45:47 PM precontured and provide better stability and functional outcome and allows higher elastic deformation than the other systems putting between rigid fixation and intramedullary nailing. The angular stability makes it ideal for comminuted fractures and intra articular fractures... Materials and Methods Fifty adult patients, of either sex, old and fresh cases and, simple or compound fractures were taken up with distal femoral fractures (lower 9 to 15 cm of femur) for the study. Written consent was taken. On admission a general physical examination followed by local examination was done and life threatening injuries were dealt on priority. The first aid in the form of Plaster of Paris (POP) back slab/splint, skeletal traction, analgesics, wound debridement, antiseptic dressings as required was done. Antibiotics and tetanus toxoid immunization was given, if required. Clinical examination was followed by radiological examination and anterior-posterior (AP) and lateral views of the knee joint and distal femur were taken and classified by A O classification. Twenty five cases were managed by surgery with dynamic condylar screw, so they were placed in group A i.e DCS group and another twenty five patients were managed by surgery with distal femoral locking compression plate hence placed in group B i.e DFLCP group. The average age at time of surgery in DCS group and DFLCP group was 43.76 yrs and 46.44years respectively. There were 19 males, 6 females in DCS group and 18 males and 7 females in DFLCP group.