DISTAL FEMUR FRACTURES FIXATION BY LOCKING COMPRESSION PLATE-ASSESSMENT OF OUTCOME BY RASMUSSEN’S FUNCTIONAL KNEE SCORE

Background: The choice of distal femur locking plate in distal femur fractures has been a topic of debate. This study was performed to evaluate theresults of distal femur locking plate in distal femur fractures. Material and Methods: A prospective randomized study of 30 patients with distalfemur fracture was conducted at Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana(Ambala), Haryana from January 2020 to July 2021 and followed up from 6months to 18 months for a minimum of 6 months duration. Implants used: The distal femur locking compression plate. Classification system: AO Classification. Results & Observations: Clinical and functional outcomes were assessed using Rasmussen's functional knee score.Complications of fractures and operative treatment were assessed. The results of entire study of 30 group 18-79 years age of 45.96 years. in age group 21-45 yearsindicating is a fracture of young people who are involved in moreactivities. the most common age group in similar studies EJYeap and Deepak (Mean age 44 years, range 15-85), Kregor et al (mean age 49 years, range 18-85), M Nayak and MR Koichade (meanage 42 years, range 21-65), Mark Miller et al (Mean age 51 years, range21-80).


Implants used
The distal femur LCP based on the locking compression platingsystem.

Surgical Technique
Patient was given pre-operative antibiotics. All patients were givenproper (spinal / epidural) anaesthesia and before proceeding adequateanaesthesia of the limb was assured. Patient was laid supine on OT table,a tourniquet was applied to the fractured limb, sterile draping wasdone.

Approach
The condyles were temporarily held reduced and fixed with K wires inseverely displaced inter condylar fractures. All wounds with type 2(Gustilo-Anderson) fractures were closed either primarily orsecondarily over a drain.The standard lateral para-patellar approach was used.

Follow up
The follow up of minimum 6 months was done. The duration of followup ranged from 6 months to 18 months. Follow up X-rays were taken toassess any failure of reduction, failure of fixation and fracture union.Patients were examined for complications.Clinical and functional outcome of all patients were analyzed byRasmussen's functional knee score on the basis of subjectivecomplaints and clinical signs.
Of the 30 patients, 22 (73.33%) were closed and 8 (26.66%) were open.Of the 30, 9 (30%) patients had associated bony injuries.The duration between day of injury and day of fixation in openfractures ranged from within 3 days, 3 -7 days. 21 patients (70%) wereoperated within 3 days and rest 9 patients (30%) were operated within7 days. The closed fractures united early as compared to open fractures. Of 30patients that were included in the study 18(60%) had range of motiongreater than 120 degrees. The type A fractures had a better range ofmovement as compared to type C fractures.

Discussion:-
Fractures of distal femur are serious injuries that have been difficult totreat and frequently results in varying degrees of permanent disability.The literature review shows various different implants and techniquesin the management of these fractures. The use of these devices requiresa certain amount of bone stock present, which limits their use in somefracture types.
The LCP is a single beam (fixed angle) construct where strength of itsfixation is equal to the sum of all screw-bone interfaces rather than asingle screw's axial stiffness and pull-out resistance as in unlockedplates. It acts as an internal fixator and functions by splinting thefracture rather than compression and hence allows a flexiblestabilization, avoidance of stress shielding and induction of callusformation.
In this study outcome of distal femur fractures which were fixed usingdistal femoral LCP has been assessed. Majority of the patients were male (73%) in active age who are moreexposed to risks such as vehicular accidents because they are moreinvolved in outdoor activities. Others authors have also noted similartrends [Ravi M Nayak and MR Koichade (male 70%), Yeap& Deepak(male 67%)].
The study by MarkWeight and Cory Collinge in a level II trauma centre also had a similarpattern. They had 12 C2, 4 A2, 3 A3 and 3 C3 fractures. The Rasmussen's functional knee score calculated at the end of followup period were excellent in 60% of our cases and good in 33.33% in ourcases. There were 18 excellent, 10 good, 1 fair and 1 poor result.
Comparison of present study with the study by Yeap et al and byWesley P et al, total 11 patients with 4 excellent, 4 good, 2 fair and 1failure.
The mean Rasmussen's functional knee score in our study was 25.13.The pain score was assessed during the evaluation of Rasmussen'sfunctional knee score. It showed that 76% of the patients had mild or nopain at all or occasional ache and bad weather pain. The aboveparameters indicates that our study had a fairly good outcome. 718

Full extension
Full range of motion

Conclusion:-
Thus, LCP is an optimal tool of good fixation system for fractures ofdistal femur. It provides rigid fixation in the region of distal femur,where a widening canal, thin cortices and frequently poor bone stockmake fixation difficult. Surgical exposure for plate placement requiressignificantly less periosteal stripping and soft tissue exposure than thatof normal plates. Therefore the distal femoral LCP provides a stablefixation in distal femur fractures.
In conclusion, the LCP represents an evolutionary approach to thesurgical management of distal femur fracture. LCP is an importantarmamentarium in treatment of fracture of distal end femur, especiallywhen fracture is severely comminuted and in situations ofosteoporosis.