Hybrid External Fixation for Open Severe Comminuted Fractures of the Distal Femur

Abstract

Background: The treatment of distal femoral open comminuted fractures is a major problem for orthopedic surgeon. The basic and important aim in treatment of these fractures is to assemble the condylar fragments and then fix the condyles to the femoral shaft by minimum handling of the bone and soft tissues. Objectives: To evaluate the treatment of distal femoral open comminuted fractures (type C2 and C3) with hybrid external fixator. Methods: Thirty-four patients with distal femur open comminuted fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. All of the fractures were opened with extension to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72 years). Average follow up period was 36 months. 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by the association for the study and application of the method of Ilizarov (ASAMI) protocol and knee society score. Results: 29 out of 34 fractures (85%) had union without bone grafts. Average time of union was 6.1 months (4 - 19 ms). The average knee range of motion was 87.5 degrees (30 - 115 degrees). The bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4 (11.8%) according to ASAMI protocol. According to the knee society score the functional results were excellent in 9 (26.44%) patients, good in 13 (38.26%), fair in 7 (20.6%), and poor in 5 (14.7%). Conclusion: Hybrid external fixator is an effective method for treatment of distal femoral open comminuted fractures (type C2 and C3) and may be considered as an alternative surgical methods in the management of these fractures.