Volume 25, Issue 108, February, 2021

A study of outcome in comminuted supracondylar femur fracture with bone loss treated with locking compression plating and fibular bone grafting

Gajanan Pisulkar¹, Swapnil Date^2♦, Kiran Saoji³, Kiran Belsare⁴, Amit Saoji⁵, Kushal Surana⁶

¹Professor, MBBS, MS Orthopaedics, J N Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: glpworld1@gmail.com;
²Junior Resident Department of Orthopaedics, J N Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: swapnildate2019@gmail.com;
³Professor and Head of Department of Orthopaedics, J N Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: kiran.saoji@gmail.com
⁴Assistant professor, MBBS, MS Orthopaedics, NKP Salve College and hospital Nagpur, Maharashtra, India
⁵Senior resident, MBBS, DNB Orthopaedics, J N Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India
⁶Assistant professor, DNB Orthopaedics, J N Medical College, Datta Meghe Institute of Medical Sciences, Wardha Maharashtra, India

^♦Corresponding author
Junior Resident Department of Orthopaedics, J N Medical College, Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra, India; Email: swapnildate2019@gmail.com

ABSTRACT

Background: Comminuted fractures of supra-condylar femur are rare, difficult to manage and challenging injuries usually associated with extensive soft tissue damage and bone loss. Due to large number of challenges presented, results are usually variable. Materials and methods: 33 patients of comminuted supra-condylar femur fracture coming to emergency department of Acharya Vinba Bhave Rural Hospital Sawangi (Meghe) Wardha who met the inclusion criteria and operated with open reduction internal fixation with plating and autologous fibula strut grafting between duration of January 2018 to June 2019 were included in the study. The study was a prospective interventional study. Observations and results: The mean age of all the patients in the study was 43.745 years. Out of 33 patients in our study 27 were males and 6 were females. In our study, out of 33 patients, in 25 patients fracture was as a result of road traffic accident while in 8 patients it was due to fall from height. All the patients in our study had associated injuries. Out of 33 fractures, 7 were Type 33A2, 12 were A3, 9 C2 and 5 C3. Out of 33, 14 fractures had intra-articular extention. Also out of 33, 13 fractures were open fractures. Out of 13 fractures, 3 fractures were Type II, 4 IIIa and 6 IIIb according to Gustillo Anderson Classification. In our study, the average duration between injury and 1st intervention was 4.5 days with maximum patients (75%) getting operated within 2 days of arrival to the hospital. Out of 13 fractures, 10 were treated in 2 staged procedures, temporary stabilization followed by permanent stabilization. Average duration between 2 procedures was 2.5 months. All the 33 patients were operated under Spinal or epiural anaesthesia. Average time required for surgery was 104 minutes. The mean duration of union was 4.8 months. All fractures united. At final follow up, functional assessment with Neer’s score was done which showed 17 had excellent results, 9 good, 6 fair and 1 patient had poor result. Conclusion: In conclusion, severely comminuted supracondylar fracture of the femur with significant bone loss can be effectively managed with distal femur locking compression plate and autologous fibula strut graft and cortico-cancellous bone graft from iliac crest. Harvesting and usage of fibula strut graft and iliac crest graft as mentioned in our study is relatively easy and cost effective and doesn’t require micro-vascular expertise.

Keywords: Comminuted supracondylar femur fracture, fibular grafting, bone gap

Medical Science, 2021, 25(108), 447-460

PDF