An
assessment of the functional results of Supracondylar and Intercondylar fractures
of distal femur treated with 95˚ angle blade plate
Singh Sanat1*, K.K.Singh2, K.K. Dhruv3
and Netam Sujata4
1Associate
Professor, Orthopaedic, Peoples College of Medical Sciences and Research
Centre, Bhopal
2Associate
Professor, Surgery, Peoples College of Medical Sciences and Research Centre, Bhopal
3Associate
Professor, Chiryau Medical College and Hospital, Bhopal 4Lecturer, Peoples Dental Academy, Bhopal
(M.P.)
ABSTRACT:
BACKGROUND: 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. These fracture
have assumed importance for continuing controversies regarding their
management. These fractures are considered to pose difficult problems for their
management because of their malalignment, incongruity and insatability. The aim
of treatment in all cases is one to obtain stable, mobile and painless joint.
OBJECTIVE: To assess the functional results of the
fractures of lower femur fractured treated by 95˚ Angle Blade Plate
fixation. Material and. METHOD: This
is an experimental study was carried out in a Medical College Hospital. A total
of 17 patients were taken as sample and treated by Angle Blade Plate fixation. Stastical
Analysis: Simple proportion and ratio.
FINDINGS AND INTERPRETATION: On analysis it was found excellent results
in 82.35% cases and satisfactory in 11.76% There was unsatisfactory results in
05.88% cases.
The results of the present study were more or less in
accordance of the findings of other studies conducted throughout globe by
different authors.
KEYWORDS: Angle blade plate, Pain, Walking capacity.
INTRODUCTION:
Supracondyler and intercondyler fractures of
the distal femur historically have been difficult to treat. These fractures
often are unstable and comminuted. Before the development of techniques and
implants to provide stable fixation, these fractures are treated conservatively
such as traction and cast bracing. With the advent of AO method of fixation, better
and more reliable internal fixation device have become available for treatment
of these fractures.. A previous generation, dazzled by the discovery of X-rays
and the transformation it brought about in the diagnosis and treatment of
fractures came to rely implicitly upon its findings and all too often made
radiological appearance the only criteria of success. The subsequent invention
and universal adoption of metallic internal fixation focused attention upon
exact reduction even where its achievement was unnecessary and means of
obtaining it actually harmful and while it facilitated earlier recovery
sometimes even prevented it.
The aim of
treatment in all cases is one to obtain stable, mobile and painless knee By keeping in mind the above facts and as per
recommendations of the World Health Organization (W.H.O.) study group in
1957,that in order to get a comprehensive picture of a disease or health
related matter, more and more such studies have to be carried out, Garg Narenra
K.(1) and Garg Narenra K. and Sharma A.B.(2), the authors have under taken this
study with the objective to assess the functional results of the Supracondylar and Intercondylar
fractures femur treated by 95˚ Angle Blade Plate (ABP).
MATERIAL AND METHODS:
This is an
experimental study. A representative cross section sample of adults patients of
both sexes of the fracture of lower femur (supracondyar and intercondylar)
coming to the department of Orthopedics and traumatology, J.A. Group of
Hospitals Gwalior (M.P.), from December, 2002 to January 2005.Only those cases
who were followed up for at least six months after operation were taken up. Thus
a total of 17 cases were included in the present study the history of accident
including mode of the injury was taken in detail. A complete clinical examination
pre-operatively as well as post-operatively of all patients was carried out. Associated
injuries and condition was assessed. Routine and special investigations as per
need were done. Treatment was started as early as possible with all
precautions. The total results score of the treatment of these fractures were
assessed as per criteria laid down by Neer C.S.et.al.(3).The data was collected
in a pre drawn pre tested proforma. Analysis was conducted and presented in a
tabular form. Stastical analysis was carried out in form of simple proportion
and ratio.
Muller's Classification
Up dated by the AO
group and adopted by the orthopedic trauma association.
Type A -Extra
articular
A1 - Simple (two part)
A2 -
Metaphyseal wedge
A3 -
Metaphyseal complex (comminuted)
Type B - Partial articular (uncondylar)
B1 - Lateral condyle(fracture in sagittal plane)
B2 -Medical condyle (fracture in sagittal plane)
B3 - Frontal (fracture in coronal plane)
Type C
Complete articular(biocondylar)
C1 -
Articular simple and metaphyseal simple (T
or Y fracture pattern)
C2- Articular
simple and metaphyseal multifragmentary
C3 - Multi-fragmentary articular
FINDINGS
AND INTERPRETATION:
On analysis of the
collected data it has been revealed that male - female ratio was 2.3:1.Harlon
S. Chiron et.al.(4) observed 60 % and 40% male and female respectively. Regarding
average age of patients ,it was 40 years which more or less in accordance of
the findings of Olerud S.et.al.(5) 37 years and 41 to 70 years respectively. These
two factors of age and sex incidence in cases of Supracondylar and
Intercondylar fractures femur, could probably due to
manifold rise in the automobile accidents in a male dominant society, the
younger age group involvement may be due to it being the active period of life.
Pain:
Out of 17 patients treated by
95˚ ABP,47.05% didn't have any pain,35.29% patients have intermittent or
during change of weather 5.88% complains of pain when fatigued,5.88% complaint
of constant pain even at night at 12thweek and 5.88% cases
complained of limits of functions (Table-I) .Table ,further reveals that at 24th.
Weeks the percentage of patients who didn't feel pain have gone up from 47.05%
to 64.70% similarly percentage of patients complaining intermittent pain had
come down and there were nil percentage of patients complaint pain at night at
the end of 24th.week Harlon S. Chiron et.al.(4) reported 25 patients
had no pain ,33 had pain occasionally or on prolonged standing ,12 had pain on
moderate activity, and 2 on movement, these findings were more or less similar
to the findings of the present study.
JOINT MOVEMENT:
Patients treated by 95˚
ABP regained good range of movement. About one third of patients treated by
95˚ ABP regained normal joint
movement and two third of patients have flexion up to 100 Harlan S. Chiron
et.al.(4) reported that 19 cases of full range motion while 8 having less
than 90˚ flexion treated with 95˚ ABP. Olerud S.et.al. (5 ) reported average
knee flexion of 104˚ to
110˚ in their series of
supracondylar fracture treated by blade plate fixation.
Walking Capacity:
At last follow up i.e. on 24th.week,
70.58% patients regain walking capacity same as before accident,23.52% were
having some limitation, and only 5.88% was unable to walk or clearly limited
(Table-II).
Work Capacity:
70%developed normal work
capacity as prior to accident at 24th. Week 5.88% after change of
occupation (Table-III).
TABLE
–I: Pain at 12th
and 24th Weeks
|
Weeks |
None |
Intermittent or during change of weather |
When fatigued |
Limits function |
Constant or at night |
Total |
|
12th |
08(47.05) |
06(35.29) |
01(5.88) |
01(5.88) |
01(5.88) |
17(100.00) |
|
24th |
11(64.70) |
04(23.52) |
01(5.88) |
01(5.88) |
---- |
17(100.00) |
Figures in parenthesis
indicate percentage
TABLE
–II: Walking
Capacity at 12th and 24th Weeks
|
Weeks |
Same as before accident |
Some Limitation |
Clearly limited |
Uses cane or severely limited |
Uses crutches or other walking aid |
Total |
|
12th |
12(70.58) |
04(23.52) |
01(5.88) |
--- |
--- |
17(100.00) |
|
24th |
12(70.58) |
04(23.52) |
01(5.88) |
--- |
--- |
17(100.00) |
Figures in parenthesis
indicate percentage
TABLE
–III: Work
Capacity at 12th and 24th Weeks
|
Weeks |
Same as before accident |
Regular but with handicapped |
Change occupation |
Light work |
No work |
Total |
|
12th |
11(64.70) |
05(29.41) |
01(5.88) |
--- |
--- |
17(100.00) |
|
24th |
12(70.58) |
04(23.52) |
01(5.88) |
--- |
--- |
17(100.00) |
Figures in parenthesis
indicate percentage
Roentgenogram:
Out of 17 cases treated by
95˚ ABP, in 47% normal anatomy was
restored and in another 47% cases angulation's of about 5˚ and in remaining 5.88% cases there was
lateral displacement of 1 cm. Harlan S. Chiron et.al.(4) reported in their
study that there were no Roentgen graphic changes in 30 cases and in 30 up to
5˚ angulations or up to 0.5 cm.
displacement and in 9 cases had 6-10˚
angulations or greater than 0.5 cm. and up to 05 displacement and 3 had 10˚ angulation or greater than 1˝ cm. displacement.
Total
score of results:
82.0% patients treated by
95˚ ABP had excellent result score while 15.38% cases treated showed
satisfactory results. On further analysis it was revealed that 5.88% and 15.38%
cases had unsatisfactory results. Juha I. Jakola et.al. (6) showed that
95˚ ABP had no mechanical advantage
.
Operative
Procedure:
ABP was considerably difficult
to insert, it was mandatory to have three dimensionally aligned. It requires
precise placement of the seating chisel in the anterior portion of the femoral
condyel to allow satisfactory axial and rotational alignment. When the chisel
is inserted any malalignment especially rotation in the saggital plane is
difficult to correct.
Complications:
5.88 % patients treated with
ABP developed superficial infection and another 5.88% had deep infection while
another 5.88% had infected non-union which were treated with implant removal
and bone grafting, later on these patients developed septic arthritis and had
persistent pain. Seinsheimer Frank III(7) in his study of47 patients of
fracture distal femur treated with various modalities reported that 8 cases of
non-union that required further surgical intervention including bone grafting
.Frank III further reported that the incidence of non-union was 17%.). Harlan
S.Chiron et.al.(4) found that out of 137 patients 4 were died,3 had infection,1
postoperative haemotoma, 2had protrusion of blade of plate and 1 had nerve
palsy.
Moderate drinking good for
aging bones: A tipple a day seems to be good for aging bones. A new study has
claimed that drinking one or two alcoholic drinks regularly could help curb
bone loss in the elderly, especially in women. Women who drink moderately –one
or two alcoholic drinks a day-have a higher bone density than non-drinkers or
heavy drinkers. The researchers from the college of public health and human
sciences at Oregon State University in the US said it is possible alcohol"
may be detrimental to the growing skeleton ,but have beneficial effects on the
aging skeleton"(9).
High-dose vitamin
"D" prevents fractures:- Vitamin not only helps build your bones by
increasing calcium absorption ,but also prevents fractures when taken in high
doses, reports a study in the New England Journal of Medicine (NEJM).Having 800
international units (IU)daily dose of vitamin "D" may help reduce the
risk of hip and other bone fractures ,said researchers from Europe and US. Two
in three fractures occur in people age 65 and older, and, by 2050, the worldwide
incidence of hip fractures is expected to more than double in women and
increase three-fold in men. Healthy adults aged 19-50 require 400 to 1000 IU
daily. Those over 50 or younger adults at high risk should receive 800 to 2000
IU daily (10).
The results of the present
study were more or less in accordance of the findings of other studies
conducted throughout the globe by different authors.
ACKNOWLEDGEMENT:
The authors expresses their sincere thanks to Dr.
A.K.Bansal, Ex-Professor and H.O.D., Department of Community Medicine, Govt.
Medical College, Jagdalpur (Bastar) India, for his constant guidance and
encouragement in preparing the manuscript.
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Received on 29.07.2012
Modified on 10.08.2012
Accepted on 16.08.2012
© A&V Publication all right
reserved
Research J. Pharmacology and
Pharmacodynamics. 4(6): November
–December 2012, 346-348