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Clinical Outcome of MIPO Technique in Complex Multi-fragmentary Distal Femoral Fractures
Keywords:
MIPO, DF-LCP, distal femoral fracture, internal fixators, bridge platingAbstract
Objective: To evaluate clinical outcome of minimally invasive plate osteosynthesis (MIPO) in complex multifragmentary distal femoral fractures. Study design: Prospective interventional study Place and duration of study: The study was conducted at Combined Military Hospital (CMH) Multan, CMH Muzaffarabad, CMH Gujranwala and CMH Rawalpindi from 1 March 2008 to 1 February 2013. Methods: 41 patients underwent MIPO for open and closed comminuted distal femoral fractures. Fractures were classified according to AO system. Open fractures were graded using Gustilo and Anderson classification. Dynamic Compression Screw (DCS) was used for fixation in 5 cases whereas 36 fractures were fixed with Anatomic Distal Femoral Locking Compression Plate (DF-LCP). Postoperative clinical and radiological assessment was done at monthly interval until radiological union and three monthly thereafter. The minimum follow-up period was eight months with a mean of 18 months: Range (8-37) months. Functional outcome was assessed in each case at final follow-up. Results: There were 35 males and 6 females with mean age of 30.3 years (Range 17-56). Radiological and clinical union was achieved in all cases. Augmentation autogenous cancellous bone grafting was done in 1 case fixed with DCS. Only 1 case got infected which was treated. Insignificant radiological mal-alignment (<5°) was observed in 4 cases. 3 cases were seen in DCS group (varus < 5o in 2 and and 4o recurvatum in 1 patient). 1 patient in DF-LCP operated group had varus of 3o. 1 plate broke in DCS group due to early weight bearing which was replaced. 2 screws broke in DCS group of delayed healing, but did not affect ultimate outcome. Mean ROM of knee at 6 months was 5-125o. Conclusion: Our experience with MIPO in appropriately indicated distal femoral fracture pattern is encouraging. However, using anatomical DF-LCP for distal femoral fractures is better than DCS due to superior biomechanical properties. Where cost is not a concern, we recommend use of anatomical locking compression plates
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