Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2016 Oct;29(4):242-249. Korean.
    Published online Oct 20, 2016.
    https://doi.org/10.12671/jkfs.2016.29.4.242
    Copyright © 2016 The Korean Fracture Society. All rights reserved.
    Original Article

    The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur

    Sam Guk Park, M.D., Jeong Jae Moon, M.D. and Oog Jin Shon, M.D., Ph.D.
      • Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea.
    • Address reprint requests to: Oog Jin Shon, M.D ., Ph.D. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3640·Fax: 82-53-628-4020, Email: ossoj@med.yu.ac.kr
    Received July 06, 2016; Revised September 17, 2016; Accepted September 21, 2016.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma.

    Materials and Methods

    Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated.

    Results

    The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores.

    Conclusion

    The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

    Keywords
    Distal femur fracture; Intra-articular fractures; Post-traumatic osteoarthritis; Mid-term

    Figures

    Fig. 1
    A 46-year-old female with metaphyseal simple and complete articular fracture with coronal plane fracture, who was injured by a fall (AO/OTA 33-C3). (A) Anteroposterior and lateral radiograph of the right distal femur fracture. (B) Computed tomography. (C) Radiographs, obtained immediately operatively, show an internal fixation. (D) Radiographs obtained at 10 months after surgery show complete bony union at the fracture site. (E) Radiographs obtained at 14 months after surgery show a device removal status. (F) Radiographs obtained at 4 years after surgery show normal alignment and no post-traumatic osteoarthritis progression.

    Tables

    Table 1
    Radiographic and Clinical Results between the AO/OTA 33-B and C Groups

    Table 2
    Selected Variables in Accordance with the Result of the Stepwise Method of Multiple Logistic Regression (Dependent Variable=Post-Traumatic Osteoarthritis Change)

    Table 3
    Comparison of Pain at the Fracture Site Pain between Short Term and Mid-Term

    Table 4
    Comparison of the Knee Society Score between Short-Term Result and Mid-Termz

    Notes

    Financial support:None.

    Conflict of interest:None.

    References

      1. Martinet O, Cordey J, Harder Y, Maier A, Bühler M, Barraud GE. The epidemiology of fractures of the distal femur. Injury 2000;31 Suppl 3:C62–C63.
      1. Stover M. Distal femoral fractures: current treatment, results and problems. Injury 2001;32 Suppl 3:SC3–SC13.
      1. Vallier HA, Hennessey TA, Sontich JK, Patterson BM. Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg Am 2006;88:846–853.
      1. Krettek C, Schandelmaier P, Miclau T, Bertram R, Holmes W, Tscherne H. Transarticular joint reconstruction and indirect plate osteosynthesis for complex distal supracondylar femoral fractures. Injury 1997;28 Suppl 1:A31–A41.
      1. Anderson DD, Chubinskaya S, Guilak F, et al. Posttraumatic osteoarthritis: improved understanding and opportunities for early intervention. J Orthop Res 2011;29:802–809.
      1. Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Intra-articular fractures of the distal femur: a long-term follow-up study of surgically treated patients. J Orthop Trauma 2004;18:213–219.
      1. Kim JJ, Choi JH. Treatment of distal femur fracture. J Korean Fract Soc 2011;24:288–293.
      1. Nork SE, Segina DN, Aflatoon K, et al. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. J Bone Joint Surg Am 2005;87:564–569.
      1. Shon OJ, Kwon MS, Park CH. Comparison of results of minimally invasive plate osteosynthesis according to types of locking plate in distal femoral fractures. J Korean Fract Soc 2012;25:269–276.
      1. Afsari A, Liporace F, Lindvall E, Infante A Jr, Sagi HC, Haidukewych GJ. Clamp-assisted reduction of high subtrochanteric fractures of the femur. J Bone Joint Surg Am 2009;91:1913–1918.
      1. Cherian JJ, Kapadia BH, Banerjee S, Jauregui JJ, Issa K, Mont MA. Mechanical, anatomical, and kinematic axis in TKA: concepts and practical applications. Curr Rev Musculoskelet Med 2014;7:89–95.
      1. Insall JN, Dorr LD, Scott RD, Scott WN. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res (248)1989;:13–14.
      1. Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q. Distal femoral fractures: current concepts. J Am Acad Orthop Surg 2010;18:597–607.
      1. Guy P, Krettek C, Mannss J, Whittall KP, Schandelmaier P, Tscherne H. CT-based analysis of the geometry of the distal femur. Injury 1998;29 Suppl 3:C16–C21.
      1. Kolb K, Grützner P, Koller H, Windisch C, Marx F, Kolb W. The condylar plate for treatment of distal femoral fractures: a long-term follow-up study. Injury 2009;40:440–448.
      1. Pettine KA. Supracondylar fractures of the femur: long-term follow-up of closed versus nonrigid internal fixation. Contemp Orthop 1990;21:253–261.
      1. Siliski JM, Mahring M, Hofer HP. Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am 1989;71:95–104.
      1. Starr AJ, Jones AL, Reinert CM. The "swashbuckler": a modified anterior approach for fractures of the distal femur. J Orthop Trauma 1999;13:138–140.
    Cited by
    Crossref 1
    Google Scholar 
    MeSH Terms
    Classification
    Femur*
    Follow-Up Studies
    Humans
    Intra-Articular Fractures*
    Knee
    Lower Extremity
    Osteoarthritis
    Prognosis
    Range of Motion, Articular
    Reference Values
    Metrics
    Share
    Figures
    slide

    1 / 1

    Tables
    slide
    slide
    slide
    slide

    1 / 4

    PERMALINK