NEW ANTEROLATERAL APPROACH OF DISTAL FEMUR FOR TREATMENT OF TYPE C DISTAL FEMORAL FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUOSong ¹ ,  DAIMin ¹ , DINGZhihui ² , ZHANGBin ¹ , ZOUFan ¹ , QIUPing ¹ , LIBinhua ¹

1. Department of Orthopaedics, the First Affiliated Hospital of Nanchang University, Nanchang Jiangxi, 330006, P. R. China;
2. the First Department of Traumatic Orthopaedics, Hongdu Hospital of Traditional Chinese Medicine;

Corresponding author：

DAIMin, Email: 413097263@qq.com

Keywords：

Type C distal femoral fracture; New anterolateral approach of distal femur; Condylar buttress plate; Internal fixation of fracture

DOI：

10.7507/1002-1892.20140094

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Objective To study the effectiveness of a new anterolateral approach of distal femur in the treatment of type C distal femoral fractures by comparing with traditional lateral and anterolateral approaches. Methods The clinical data of 51 patients with type C distal femoral fractures treated between January 2008 and August 2011 were retrospectively analyzed. Of 51 patients, 24 patients received the new anterolateral approach of distal femur combined with fixation of condylar buttress plate (modified group), and 27 patients underwent traditional lateral or anterolateral approach combined with fixation of condylar buttress plate (traditional group). There was no significant difference in gender, age, injury cause, American Society of Anesthesiologist (ASA) classification, side, fracture type, complication, and the time from injury to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, frequency of intraoperative fluoroscopy, hospitalization time, fracture healing time, and Hospital for Special Surgery (HSS) scores of the knee at 3, 6, and 12 months were recorded. Results The operation was successfully completed and the incision healed by first intention in all patients. The operation time and frequency of intraoperative fluoroscopy of modified group were significantly less than those of traditional group (P<0.05). But the intraoperative blood loss and the hospitalization time showed no significant difference between 2 groups (P>0.05). All patients were followed up 12-37 months (mean, 21.3 months). X-ray films showed all fractures were union. The fracture healing time was (12.92±2.24) weeks in the modified group and (13.24±2.52) weeks in the traditional group, showing no significant difference (t=0.476, P=0.637). The knee HSS scores of modified group were significantly higher than those of traditional group at 3, 6, and 12 months after operation (P<0.05). There was no significant difference in the incidence of knee varus or valgus, leg length discrepancy, internal fixator loosening, flexing dysfunction of knee, traumatic arthritis of knee, and total complications between 2 groups (P>0.05). Conclusion Comparing with traditional lateral and anterolateral approaches, using the new anterolateral approach to treat type C distal femoral fractures has the advantages of less damage to soft tissue, excellent exposure, less operation time, and frequency of intraoperative fluoroscopy, and better postoperative rehabilitation of knee joint.

Citation： LUOSong, DAIMin, DINGZhihui, ZHANGBin, ZOUFan, QIUPing, LIBinhua. NEW ANTEROLATERAL APPROACH OF DISTAL FEMUR FOR TREATMENT OF TYPE C DISTAL FEMORAL FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 414-418. doi: 10.7507/1002-1892.20140094 Copy

1.	Ng AC, Drake MT, Clarke BL, et al. Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984-2007. Osteoporos Int, 2012, 23(6):1721-1726.
2.	Kim J, Kang SB, Nam K, et al. Retrograde intramedullary nailing for distal femur fracture with osteoporosis. Clin Orthop Surg, 2012, 4(4):307-312.
3.	胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 4版. 北京:人民军医出版社, 2012:984-985.
4.	Johnson KD, Hicken G. Distal femoral fractures. Orthop Clin North Am, 1987, 18(1):115-132.
5.	Rademakers MV, Kerkhoffs GM, Sierevelt IN, et al. Intra-articular fractures of the distal femur:a long-term follow-up study of surgically treated patients. J Orthop Trauma, 2004, 18(4):213-219.
6.	Johnson EE. Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur. Clin Orthop Relat Res, 1988, (231):154-162.
7.	Bolhofner BR, Carmen B, Clifford P. The results of open reduction and internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma, 1996, 10(6):372-377.
8.	Ostrum RF, Geel C. Indirect reduction and internal fixation of supracondylar femur fractures without bone graft. J Orthop Trauma, 1995, 9(4):278-284.
9.	Henderson CE, Kuhl LL, Fitzpatrick DC, et al. Locking plates for distal femur fractures:is there a problem with fracture healing? J Orthop Trauma, 2011, 25 Suppl 1:S8-S14.
10.	骆松, 戴闽, 张斌, 等. 改良股前外侧入路治疗股骨远端C型骨折的应用解剖. 中国临床解剖学杂志, 2013, 31(4):376-383.
11.	张斌, 戴闽, 邹帆, 等. 新型股骨远端前外侧入路治疗股骨远端骨折疗效观察. 中国修复重建外科杂志, 2013, 27(11):1296-1299.
12.	戴闽. 实用骨科治疗与康复. 北京:人民卫生出版社, 2007:206-210.
13.	Schütz M, Müller M, Regazzoni P, et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures:a prospective multicenter study. Arch Orthop Trauma Surg, 2005, 125(2):102-108.
14.	Vallier HA, Hennessey TA, Sontich JK, et al. Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg (Am), 2006, 88(4):846-853.
15.	Herrera DA, Kregor PJ, Cole PA, et al. Treatment of acute distal femur fractures above a total knee arthroplasty:systematic review of 415 cases (1981-2006). Acta Orthop, 2008, 79(1):22-27.
16.	骆松, 张斌, 戴闽. 股骨远端骨折手术入路的现状. 南昌大学学报:医学版, 2013, 53(6):101-103.
17.	Kanamiya T, Whiteside LA, Nakamura T, et al. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res, 2002, (404):24-31.
18.	Sher I, Umans H, Downie SA, et al. Proximal iliotibial band syndrome:what is it and where is it? Skeletal Radiol, 2011, 40(12):1553-1556.
19.	Stover M. Distal femoral fractures:current treatment, result and problems. Injury, 2001, 32 Suppl 3:SC3-13.
20.	韩健, 殷振华, 陈轲, 等. 股骨髁部粉碎骨折的治疗研究进展. 骨科, 2011, 2(2):107-110.

1. Ng AC, Drake MT, Clarke BL, et al. Trends in subtrochanteric, diaphyseal, and distal femur fractures, 1984-2007. Osteoporos Int, 2012, 23(6):1721-1726.
2. Kim J, Kang SB, Nam K, et al. Retrograde intramedullary nailing for distal femur fracture with osteoporosis. Clin Orthop Surg, 2012, 4(4):307-312.
3. 胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 4版. 北京:人民军医出版社, 2012:984-985.
4. Johnson KD, Hicken G. Distal femoral fractures. Orthop Clin North Am, 1987, 18(1):115-132.
5. Rademakers MV, Kerkhoffs GM, Sierevelt IN, et al. Intra-articular fractures of the distal femur:a long-term follow-up study of surgically treated patients. J Orthop Trauma, 2004, 18(4):213-219.
6. Johnson EE. Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur. Clin Orthop Relat Res, 1988, (231):154-162.
7. Bolhofner BR, Carmen B, Clifford P. The results of open reduction and internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma, 1996, 10(6):372-377.
8. Ostrum RF, Geel C. Indirect reduction and internal fixation of supracondylar femur fractures without bone graft. J Orthop Trauma, 1995, 9(4):278-284.
9. Henderson CE, Kuhl LL, Fitzpatrick DC, et al. Locking plates for distal femur fractures:is there a problem with fracture healing? J Orthop Trauma, 2011, 25 Suppl 1:S8-S14.
10. 骆松, 戴闽, 张斌, 等. 改良股前外侧入路治疗股骨远端C型骨折的应用解剖. 中国临床解剖学杂志, 2013, 31(4):376-383.
11. 张斌, 戴闽, 邹帆, 等. 新型股骨远端前外侧入路治疗股骨远端骨折疗效观察. 中国修复重建外科杂志, 2013, 27(11):1296-1299.
12. 戴闽. 实用骨科治疗与康复. 北京:人民卫生出版社, 2007:206-210.
13. Schütz M, Müller M, Regazzoni P, et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures:a prospective multicenter study. Arch Orthop Trauma Surg, 2005, 125(2):102-108.
14. Vallier HA, Hennessey TA, Sontich JK, et al. Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg (Am), 2006, 88(4):846-853.
15. Herrera DA, Kregor PJ, Cole PA, et al. Treatment of acute distal femur fractures above a total knee arthroplasty:systematic review of 415 cases (1981-2006). Acta Orthop, 2008, 79(1):22-27.
16. 骆松, 张斌, 戴闽. 股骨远端骨折手术入路的现状. 南昌大学学报:医学版, 2013, 53(6):101-103.
17. Kanamiya T, Whiteside LA, Nakamura T, et al. Effect of selective lateral ligament release on stability in knee arthroplasty. Clin Orthop Relat Res, 2002, (404):24-31.
18. Sher I, Umans H, Downie SA, et al. Proximal iliotibial band syndrome:what is it and where is it? Skeletal Radiol, 2011, 40(12):1553-1556.
19. Stover M. Distal femoral fractures:current treatment, result and problems. Injury, 2001, 32 Suppl 3:SC3-13.
20. 韩健, 殷振华, 陈轲, 等. 股骨髁部粉碎骨折的治疗研究进展. 骨科, 2011, 2(2):107-110.

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NEW ANTEROLATERAL APPROACH OF DISTAL FEMUR FOR TREATMENT OF TYPE C DISTAL FEMORAL FRACTURES

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