Epidemiological Profile of Fractures of Lower Femur Patients

Singh Sanat*, Dwivedi S.K., Bansal A.K. and Netam Sujata

Govt. Medical College, Jagdalpur ( Bastar ) – 494001 INDIA.

ABSTRACT:

Back ground : Knee joint is highly complicated mechanism composed of a wide variety of specialized connective tissue which have to at one and the same time bear weight but resist considerably shearing and angulations stresses ,posses mobility without loss of stability ,avoid fatigue but act as a powerful unit for propulsion. Objective: To analysis the factors responsible for the fracture. Material and Methods: Data of thirty patients admitted in a medical college hospital was collected in a pre-designed proforma. Variables: include – age, sex, profession, Type of accidents, side of involvement, and associated injuries if any. Statistical analysis: expressed in terms of simple proportion and ratio. Findings: The male female ratio was 2.3: 1. Road traffic accidents were the cause of fracture in 80 % of the cases rest 20 % was fall from a height. 43.33 % did not have any associated injuries .36.66 % injured were from service class and 26.66 %were house wives. More than 62.5 % house wives received injury because of fall from a height. Conclusion : Involvement of high proportion of service class was because of their higher exposure, similarly more proportion of females got injuries because of fall indicate their negligence .This all indicate that an awareness drive have to be carried out about various causes of accidents among the masses.

KEYWORDS: Awareness, Accidents

INTRODUCTION:

There can be little doubt that injury to the knee is being seen with increasing frequency. High velocity injury sustained by automobile in road traffic accidents as a whole is creating an ever growing problem .The knee has become the most vulnerable of all joints since man has taken to traveling at high speeds in a squatting position with “the leading edge “composed of flexed hind limbs .When the machine on or in which the subject is traveling stops suddenly, much of the Impact is taken first up on the patella, then the condyles of the femur.

Femoral condyles are also commonly fractured by the subject falling from a height or sustaining a crush injury when the knee is flexed .By keeping in mind the above facts and as very few reports of such studies were available and in 1957 a study group of World Health Organization (W.H.O.) has expressed the view that in order to get a comprehensive picture of disease more and more studies have to be carried out, Garg Narendra K. (2). This prompted the authors to undertake this study to find out the factors responsible for the fracture.

MATERIAL AND METHODS:

A representative cross section of adults patients of the fracture of lower femur (supracondyler and intercondyler) of both sexes attending the Department of Orthipaedics and Traumatology, of a Medical College, Hospital were taken up for this study. The history of the accident were taken in detail and possible mechanism of sustaining fractures in the accident were construed.

A note of the mode of the injury was made especially as regards the automobile accidents whether the victim was hit by the automobile or was an occupant of it. All enteries were made in a predesigned, pre tested proforma. Statistical analysis was done and expressed in simple terms of proportion and ratio.

The patients were examined clinically in detail on arrival taking following in to consideration – General condition was assessed and shock, if present, was managed appropriately. Overlying skin for the presence of abrasions / bruises suggestive of the site of the impact and for the presence of wound and compound fracture .The presence of large effusion in the knee was suggestive of intercondyler extension of fracture, supracondyler or presence of any serios ligamentous injuries. Crepitus and abnormal mobilities were not tested. Radiographic studies were relied upon instead, to avoid hurting the patients.

After the initial clinical examination the patient was subjected to X-ray examination of the part. Standard antero-posterior and lateral views were taken. The associated injuries were also examined radiologically to facilitate appropriate treatment.

FINDINGS:

On analysis of the collected data, it was revealed that maximum was in 21 to 40 years of age group which is most active period of life (Table – I). As far as gender was concerned the male to female ratio was 2.3: 1.Table further reveals that right side was predominantly injured in 60.00 %cases in comparision to left side 40.00 %.

(Table – II ) shows that most of the patients were victim of road traffic accidents (R.T.A. ) i.e. 80.00 % and 20.00 %injured by a fall from a height .Table further reveals that 43.33 % patients didn’t received any associated injury while equal proportion i.e. 43.33% received injury to the Ipsilateral lower limb and contralateral lower limb and only 6.66 %got injury to the Ipsilateral and contra lateral upper limb .3.33 %cases also received associated injury in head and equal proportion in chest. (Table - III) reveals that maximum proportion of cases (36.66 %) were belong to service class followed by 26.66 %house wives .On further analysis out of 26.66 %house wives maximum 62.5 %were got injury because of fall from a height .Table further shows that 10..00 %each of businessman, labour and student and only 3.33 %shopkeeper got injured.

INTERPRETATIONS:

Various studies conducted by various authors noted that patients fractured were of young active age group. in the present study average age of patients were 40 years. Harlan S.et al (2) reported in his study that most of the patients were between 41 to 70 years of age.

Slatis P. et al (3) reported average age of patient in his series was 37 years. Olerud S. et al (4) reported a group of patients treated whose age was 45 years. Schatzker J. et al (5) Evaluated postoperative roentgenograms of patients treated with the ASIF condyler plate. They divided their patients in to a group treated in accordance of the principle of rigid internal fixation and a group classified as others, the patients judged properly treated had an estimated average age of 42 years and improperly treated 61 years .

Regarding sex was concerned the male –female ratio was 2.3: 1.in the present study. Harlan S. et al (2) reported in his study of supracondyler fracture of femur were 60% male and 40% female this shows that males are more exposed to outside work eg. Service, business, labour etc.

Side involvement –in the present study in 60 % of the cases right side were involved in comparision to 40 % left side. Frank Seinsheimer III (6) reported that out of 45 patients and 47 fractures involved 33 fractures involved right leg and 14 left leg which were more or less in accordance of the findings of the present study.

Most of cases (80%) were victim of RTA 20% cases had injury by fall from height. They were either driving or wre an occupant of a vehicle, mostly the vehicle being a two wheeler the incidence of these fractures is due to tremendous expansion of the automobile industry all over. 6 patients (20%) sustained injury due to fall from height.

In our study most of the males were victims of motor bike accidents.

Harlan S. Chron MD (2) reported most of the patients were victim of road traffic accident (69.63%).

As most of our patients sustained injury due to RTA. Most of there were also having other musculoskeletal injuries, among which ipsilateral lower limb trauma was most common (30%) cases. One patient was also having head injury and one having chest.

Table – I: Side of Involvement as per Age and Gender

Age (in years)	Male n= 21		Female n=09
Age (in years)	Left n=07	Right n=14	Left n=05	Right n=04
0 - 10	00 (00.0)	00 (00.0)	00 (00.0)	00 (00.0)
11 - 20	00 (00.0)	00 (00.0)	00 (00.0)	01 (25.00)
21 - 30	02 (28.57)	03 (21.42)	02 (40.00)	00 (00.0)
31 - 40	02 (28.57)	07 (50.00)	01 (20.00)	01 (25.00)
41 - 50	00 (00.0)	03 (21.42)	01 (20.00)	01 (25.00)
51 - 60	02 (28.57)	01 (7.14)	00 (00.0)	00 (00.0)
61 - 70	01 (14.28)	00 (00.0)	01 (20.00)	00 (00.0)
71 and above	00 (00.0)	00 (00.0)	00 (00.0)	01 (25.00)
	07 (100.00)	14 (100.00)	05 (100.00)	04 (100.00)

Figures in parenthesis indicate percentage.

Table – II: Associated Injuries as per Mode of Accidents and Side of Involvement

Age (in years)	Left side n= 12		Right Side n=18		Total
Age (in years)	R.T.A.	Fall	R.T.A.	Fall	Total
No injury	05	01	05	02	13
Injury to lower limb	05	01	06	01	13
Injury to upper limb	Nil	Nil	02	Nil	02
Head Injury	Nil	Nil	01	Nil	01
Chest Injury	Nil	Nil	01	Nil	01
Injury to pelvis	Nil	Nil	Nil	Nil	Nil
Vascular deficit	Nil	Nil	Nil	Nil	Nil
Total	10	02	15	03	30

Table – III: Involvement as per Profession

S. N.	Profession	Male		Female		Total
S. N.	Profession	Left	Right	Left	Right	Total
1.	Shopkeeper	01	Nil	Nil	Nil	01
2.	Service	03	08	Nil	Nil	11
3.	Housewife	Nil	Nil	05	03	08
4.	Businessmen	02	01	Nil	Nil	03
5.	Labour	Nil	03	Nil	Nil	03
6.	Student	01	01	Nil	Nil	03
7.	Farmer	Nil	01	Nil	01	01
Total		07	14	05	04	30

The traffic accident and fatalities report, which forms a part of the “accidental death in India “document prepared by the National crime records bureau, has revealed that India’s road death record has worsened with fatalities crossing 1.26 lakh in 2009 against 1.18 lakh in 2008 .The data further shows that at least 14 persons are killed every hour on Indian roads while 56 persons are injured in road accidents.

As per data of National Crime Records bureau’s annual reports 2009 (10) stated that nationwide accidental deaths including those in road mishaps increased by 7.3% (around 3.57 lakh died accidental deaths) over the last year i.e. in 2008.

The finding of the present study indicate that lot of efforts to be made to bring awareness in the masses about various aspects of Accidents, which is similar to the views expressed by Bansal and Chandorkar (7) in their study.

From the above observations and discussion the author reached to the conclusion that by taking in to account, the findings of the present study and other studies conducted by different authors from time to time in different parts of the country. We must formulate Behaviour Change Communications which is essential to cater the needs of different sections of the society, otherwise the knowledge and technology provided to us by our great scientists to control accidents will all go to vain and the objective of strategy will remain simply nothing more than a nightmare.

ACKNOWLEDGEMENT:

The Authors expresses their sincere thanks to Shri Anand Singh Kanwar, Lab-Technician, Dept. of Community Medicine, Govt. Medical College, Jagdalpur for his efficient typing without his help this paper could not come in this form.

REFERENCES:

1. Garg Narendra K. Evaluation of the impact of emesis and emesis plus purgation therapy; Research J. Pharmacology and Pharmacodynamics: 2 (2) March – April 2010; 201-202.

2. Harlan S. Chiron, Jean Tremoulet, Patrick Casey & Maurice Muller-Fractures of the distal third of the femur treated by internal fixation, Clinical Ortho. And Related Research, No. 100, 1974.

3. Slatis, P. Ryoppy, S. Huittinen, V.M. – AOL osteosynthesis of the fractures of the distal third of the femur, Acta Orthop. Scand, 42: 162, 1971.

4. Olerud, S. – Operative treatment of supracondylar – condylar fractures of the femurm Technique and results in fifteen cases, Journal of Bone and Joint Surgery, 54-A: 1015, 1972.

5. Schatzker J., Mahomed N., Schiffman K., Kellam J. – Dynamic condylar screw: a new device. A preliminary report, J. Orthop. Trauma, 1989; 3 (2): 124-32.

6. Seinsheimer, Frank III – Fracture of the distal femur, Clin. Orthop. 153: 169-179, 1980.

7. Bansal A.K. and Chandorkar R.K. 1997 Tribal Health Bulletin (ICMR) 3 (2), 12.

8. Bansal A.K. and Chandorkar R.K. 1998 Tribal Health Bulletin (ICMR) 4 (1), 10.

9. Bansal A.K. and Chandorkar R.K. Impact of I.C.D.S. on morbidity due to Nutritional deficiency Diseases amongst Tribe and Non Tribe Children; Research J Science and Tech.; 2009: 1(2); 82-84.

10. 1326 Indians die daily in accidents, suicides; The Times of India, New Delhi, 18^th January, 2011; pp-01.

Received on 25.05.2011

Modified on 20.06.2011

Accepted on 29.06.2011

Research J. Pharmacology and Pharmacodynamics. 4(1):Jan. - Feb., 2012, 34-36