The Clinical Research Of The Treatment Of Distal Femur Fracture With Posterolateral Approach And Locking Compression Plate

Objective: With the accelerating development of modern societyindustry and traffic, the incidence of distal femur fracture is higher and thetendency is rising. Now the distal femur fracture is common, representing4%~7%of all the femur fracture and0.4%of all the fracture dislocation. Thedistal femur fracture always involve in intra-articular fracture or the fracturelocation is near the knee joint, as the result the fracture always effect themovement and function of the knee joint and the incidence of fracturenonunion, delayed union of fracture or infection is higher. Epidemiologicstudies reflect these injury patterns, showing peaks in incidence in youngpeople and elderly people. One always occur in young who sustainhigh-energy trauma and another always occur in elderly who with osteoporosissustain low-energy trauma. Now the incidence of the distal femur fracturebecause of high-energy trauma increase and can be more complex leading tomore complications and high disability rate. As we all know, good reductionof fracture, firmly fixation and functional exercise early is the generallyaccepted foundation of the fracture healing and functional recovery. In thepast, because of lacking useful material of internal fixation, we always chooseconservative treatment to treat distal femur fracture just like skeletal traction,plaster fixation after manual reduction or the treatment of electricalstimulation. But there are many disadvantages in the conservative treatmentwhich are the long treatment time and many complications like pain, malunionor the ankylosis of knee. These years, as the development of material ofinternal fixation, many scholars emphasize to choose operation to treat distalfemur fracture. It is well known that many factors effect fracture healing andall the treatment should accord with the principle of the biology and mechanical which is the blood supply of bone and the normal physiologicaland mechanical environment of the bone. Considering the anatomicalcharacteristics of the distal femur especially femoral condyle, it is very hard toreduction and fixation the displacement fracture fragment of the distal femurfracture. In clinical we should choose the best treatment protocols according tofracture classification, wound degree, the conditions of soft tissue, theconditions of osteoporosis,the systemic conditions and economic condition ofthe patients, the experience and technical level of the doctor and so on. Theoperation may be very difficult due to the severe comminuted fracture of thedistal femur，bone defect and skin injury. The operation were not satisfactorybecause they can not be got anatomical reduction．As the result, the distalfemur fracture always present a significant challenge to the orthopedic surgeon.Now there is not a normal principle of the surgical approach to treat the distalfemur fracture. The most important theme of the treatment is how to reducethe trauma of operation, to maintain the anatomical structure around the kneejoint, to reach satisfied reduction, to reach the anatomical structure of thefemur articular surface, to use the perfect material of internal fixation, toincrease the functional exercise of knee joint early, to reduce the time offracture healing, to reduce the incidence of nonunion and infection and toreduce the complication as the ankylosis of knee, knee joint adhesion and soon.Through observations of20cases of distal femur fracture since2010, weinvestigate the superiority of the treatment of the distal femur fracture withposterolateral approach and locking compression plate, to reduce the trauma ofoperation and increase the function of the knee joint, and to increase theoperative effect and to help the clinicians provide reference material aboutthe surgical approach of the treatment of distal femur fracture. Then wediscuss other relevant issues of the treatment of distal femur fracture either.Methods: Observation of20cases of distal femur fracture since2010inThe Third Hospital of He Bei Medical University, including9males and11females, aged22to77years, mean44years. The injury was caused by traffic accident in8cases, by skipping in11cases and by crush injury in1case.There were3open fractures and17close fractures. According to AO/OTAclassification, the fractures were classified as A1in2cases, A2in2cases, A3in6cases, C1in1cases, C2in7cases, C3in2cases. All the patients were treatedby the posterolateral approach and locking compression plate which werefollowed up after surgery. And then the healing of the wounds, the healing offracture and the recovery of function of knee joint were observed.Results: The wounds of all the patients were primary healing. All the20patients were followed up for6to18months, mean12months.19patientswere involved in fracture healing, and1patient was obverted by15monthsafter operation who need to be taken another operation of planting bone.According to the evaluation standard of Kolmert, there were excellent in8cases, good in10cases, fair in2cases. The range of knee flexion-extensionwas over120°in8cases,90°~120°in10cases,70°in1cases,40°in1cases.Conclusions: The treatment of distal femur fracture with posterolateralapproach and locking compression plate cause little trauma, minimize theinjuries of the soft tissue to retain the blood supply around the fracture and toretain the anatomical structure of the knee joint. The patients can do thefunctional exercise early to improve the function of the affected limb.Theoperation is relatively simple, which is in favour of generalization in primaryhospital. The treatment can improve the cure rate of distal femur fracture andthe effect is exact which has certain superiority.