SP5.2.2 Our Management of Distal Femoral Comminuted Fractures with Femoral Defects. (9th August 2022)

• Record Type: Journal Article
• Authors: Zhou, Andrew; Jou, Eric; Patel, Shaan; Lu, Victor; Zhang, James; Krkovic, Matija
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 5
• Publication Date: 2022-08-09
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac247.053
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aim: Distal femoral fractures account for 3–6% of all femoral fractures. Current management of distal femoral fractures involve reducing bone fragments and placing a locking plate against it. In this study, the surgeon used a 'selective approach', whereby only key bone fragments in the comminuted fracture were reduced and fixed whilst the rest were either removed or left unreduced/unfixed. Method: All patients underwent AxSOS plate/less invasive stabilisation system (LISS) surgery for their comminuted femoral fracture after adopting the "selective approach" during pre-surgical planning. A significant proportion of patients had a degree of bone defect, and most had open fractures. Primary outcomes included post-operative functional ability, quality of life assessed using EQ-5D-5L, Oxford Hip Score (OHS), Oxford Knee Score (OKS), range of movement. Results: Average OKS and OHS for our cohort (n=10) is 23 and 35, respectively, with a mean knee-flexion of 86° (45°-120°). Average EQ-5D- 5L index value is 0.551; the most common response for mobility, self-care, usual activities, pain/discomfort, and anxiety/depression was moderate. 20% developed pin site infections, 40% reported significant knee stiffness. Conclusions: Despite a complex cohort whereby many patients had bone defects, and 80% had open fractures, the "selective approach" adopted in the present study achieved comparable outcomes to other studies with less-severe fracture characteristics, with similar operation times and range of knee-flexion. These results suggest that this alternative should be considered as a treatment option, although more studies on a similar cohort of patient to ours is needed to allow better comparison of the surgical approaches.