SYNOPSIS

APRIL 2015 SESSION

STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMUR

FRACTURE USING LOCKING COMPRESSION PLATE

By
DR.KUMAR SAURAV

Under The Guidance Of

DR. TUSHAR AGRAWAL

Associate Professor
Department of Orthopaedics
DR. D. Y. PATIL MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTRE,
PIMPRI, PUNE 400018

1
To

The Dean,

Dr.D.Y.PATIL MEDICAL COLLEGE & HOSPITAL,PIMPRI, PUNE 411018

TOPIC OF DISSERTATION: M.S (ORTHOPAEDICS)

RESPECTED SIR,

I HAVE REGISTERED MY NAME WITH YOUR ESTEEMED UNIVERSITY FOR

THE DEGREE OF M.S (ORTHOPAEDICS) IN APRIL 2015 UNDER THE

GUIDANCE OF Dr.TUSHAR AGRAWAL, ASSOCIATE PROFESSOR,

DEPARTMENT OF ORTHOPAEDICS, PADMASHREE Dr.D.Y.PATIL MEDICAL

COLLEGE & RESEARCH CENTRE, PIMPRI , PUNE 411018.

THE SUGGESTED TOPIC OF MY DISSERTATION IS AS FOLLOWS

STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMUR

FRACTURE USING LOCKING COMPRESSION PLATE. It is required

that approval of the above mentioned topic may please be accorded.

THANKING YOU

YOURS FAITHFULLY

DR.KUMAR SAURAV

2
To
The Registrar,
Dr.D.Y.PATIL UNIVERSITY
PIMPRI, PUNE 411018
TOPIC OF DISSERTATION: M.S (ORTHOPAEDICS)
RESPECTED SIR ,
I HAVE REGISTERED MY NAME WITH YOUR ESTEEMED UNIVERSITY FOR
THE
DEGREE OF M.S ORTHOPAEDICS IN APRIL 2015 UNDER THE GUIDANCE OF
Dr.TUSHAR AGRAWAL, ASSOCIATE PROFESSOR, DEPARTMENT OF
ORTHOPAEDICS, PADMASHREE Dr.D.Y.PATIL MEDICAL COLLEGE &
RESEARCH CENTRE, PIMPRI , PUNE 411018.

THE SUGGESTED TOPIC OF MY DISSERTATION IS AS FOLLOWS-

STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMUR

FRACTURE USING LOCKING COMPRESSION PLATE . It is
required that approval of the above mentioned topic may please be
accorded.
Thanking you
YOURS FAITHFULLY

DR KUMAR SAURAV

3
 REMARKS FROM THE POST GRADUATE GUIDE

A SYNOPSIS OF THE PROPOSED TOPIC OF DISSERTATION OF M.S.

(ORTHOPAEDICS) EXAMINATION OF PADMASHREE D.Y. PATIL MEDICAL
COLLEGE & RESEARCH CENTRE, PIMPRI, PUNE-411018.

Recommended to pursue the study for dissertation of

Said topic under my guidance.

TOPIC

STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMUR

FRACTURE USING LOCKING COMPRESSION PLATE

NAME OF P.G. STUDENT DR.KUMAR SAURAV

SIGNATURE of P.G. GUIDE DR. TUSHAR AGRAWAL

Associate Proffesor,
Department of Orthopedics
Padmashree Dr. D. Y. Patil
Medical College & Research
Centre, Pimpri, Pune-411018

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 REMARKS FROM THE HEAD OF DEPARTMENT (ORTHOPAEDICS)

A SYNOPSIS OF THE PROPOSED TOPIC OF

DISSERTATION OF M.S (ORTHOPAEDICS)
EXAMINATION OF PADMASHREE DR.D.Y. PATIL MEDICAL COLLEGE &
RESEARCH CENTRE, PIMPRI, PUNE-411018.

TOPIC

STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMUR

FRACTURE USING LOCKING COMPRESSION PLATE

NAME OF THE PG GUIDE: DR.TUSHAR AGRAWAL

NAME OF THE PG STUDENT: DR.KUMAR SAURAV

Dr. SANJAY DEO

Professor and Head of Department
Padmashree Dr. D .Y. Patil Medical
College & Research Centre
Pimpri, Pune-411018

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 INDEX

NO TITLE Page No.

1 INTRODUCTION 7

2 AIMS AND OBJECTIVES 8

3 REVIEW OF LITERATURE 9

4 MATERIALS AND METHODS 10-14

5 REFERRENCES

6 APPENDIX A-CONSENT FORM

B PROFORMA & QUESTIONNAIRE

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 1.INTRODUCTION

1.1 Distal femur fractures present considerable challenge in management.

They are due to high energy trauma with extensive soft tissue injury with
articular and metaphyseal involvement. This type of fracture poses many
challenges to the surgeon viz., thin cortex, wide medullary canal, relative
osteopenia, short condylar fractures and communition.1

1.2 Before 1970 Studies advised conservative treatment for distal femur
fractures. Later studies advised operative treatment and angular blade
plate had significantly higher torsional stiffnes than other constructs.
Locking compression Plate evolved from conventional plates and is widely
used nowadays because of biomechanical advantage.1,2

1.3 The principle of the Locking compression plate is to have rigid fixation
close to the bone and under the soft-tissue envelope and can be applied
without stripping periosteum which is very much essential for fracture
healing. The Locked plates have a provision to insert many number of
screws in to diaphysis for maximum fixation. 2

1.4 Studies have shown conflicting reports of success but still LCP is
being used rampantly in Distal Femur Fractures. So the need for the study
is to assess the effectiveness of the device in achieving fracture union and

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to know the rate of complications associated with the devices.

2.AIMS AND OBJECTIVES

2.1 AIM
2.1.1 To study the union rates with locking compression plates.

2.2 OBJECTIVES
2.2.1 Knee Range of movements
2.2.2 Pain relief
2.2.3 Return to normal activities and work.

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 3.REVIEW OF LITERATURE

3.1 Locked plating or angular stability was originally described by Wolter

in 1927 and Reinhold in 1931.2 Studies till the 1960s revealed non
operative treatment for distal femur fractures were better than open
reduction.

3.2 LISS or Less invasive stabilization system developed in the 1970's

used unicortical locking screw.

3.3 Locking plates in the present form was designed by Robert Frieg,
based on an idea by Prof Micheal Wagner. It was initially used for Spinal
and Facio-maxillary surgery.

3.4 First clinical results of the Locking plate in March 2000 on 18 femoral
fractures, 57 tibial, 45 humerus, 19 radius showed a 86% healing. 4

3.5 Study of Locking condylar plate fixation in distal femoral fractures

showed a failure of LCP in 6 out of the 46 (14%) study patients and
concluded that failure was due to inadequate plate size and unicortical
screws.3

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3.6 Study of 26 Distal Femur fractures in multiply injured patients using
LCP showed no nonunions, no infections and excellent range of motion. 2
A Study of 64 patients recently for fixation of Distal Femur fractures using
locking plates showed inconsistent, asymmetric callus formation. 5

4. Materials and Methods

4.1 Materials

4.1.1 Locking compression plates (Distal Femoral Locking Plate)

4.1.2 Screws of Appropriate size (Locking type)

4.9 mm and 6.5 mm with drill bits of 4.3 mm and 4.5 mm
respectively
4.1.3 Screws of appropriate size (non locking type)
4.5 mm with drill bit of 3.2 mm
4.1.4 Screw-Driver of 4.5 mm

4.2 Methods

4.2.1 Institute Ethics Committee Clearance will be obtained before

the start of the study.

4.2.2 Type of study: Prospective

4.2.3 Period of study: -april 2015 to november 2018
4.2.4 Period required for data collection:-2 year.
4.2.5 Period required for data analysis and reporting: - 6 months.
4.2.6 Place of study Dr.D.Y.Patil Medical College Pimpri.Pune

4.3 INCLUSION CRITERIA

4.3.1 All patients with distal femur fractures treated with LCP

4.3.2 All skeletal mature patients(>18years)

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 4.3.3 Patients with osteoporosis.

4.3.4 Open distal femur fractures up to type I, II and III A

4.3.5 Patients willing to give consent

4.4 EXCLUSION CRITERIA

4.4.1 Patients of age less than 18 yrs

4.4.2 Open fractures type III B and C

4.4.3 Pathological Fractures

4.4.4 Associated tibial plateau fractures

4.4.5 Non union and Delayed union

4.5 PROCEDURE

4.5.1 A total of 30 cases

4.5.2 On admission detailed history & the complaints of the patients will
be noted, along with a thorough clinical examination.
4.5.3 X-RAY of femur anteroposterior and lateral views
4.5.4 All routine investigation will be done prior to anesthesia fitness.
4.5.5 Pre-operative anesthesia fitness will be done.
4.5.6 Patient will be posted for planned operative procedure.

4.5.7 Post of Management

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 IV antibiotics will be given for the first 5 days & then will bE shifted to
oral antibiotics.
Anti-inflammatory & analgesics drugs & other supportive drugs will
be given.
Post-operative dressing of the surgical wound will be done on
2nd, 5th, & 8th day. Sutures will be removed on 12th post-operative
day
Appropriate physiotherapy will be started from 2nd post-operative
day.First passive, gradually moving on to active.

4.6 FOLLOW UP
4.6.1 Patient will be followed up in Out Patient Department fortnightly
for a period of 1 Month post-operatively, then at 3 months, 6 month & if
necessary 1 year
4.6.2 At follow-up following things will be examined
Signs of Healing of fracture clinically and the radiologically at the
end of 6 weeks
Tenderness at the fracture site

Pain if any & its degree

Any other subjective complaint

Local examination:

Asses the local wound.

Swelling of the joint.

Movement of the limb-active & passive.

Power & Tone of muscles.

Presence of any obvious inflammation.

Any Neurovascular Complications.

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EVALUATIONS

Neers scoring system 6

Functional (70 points) Anatomical (30 points)

a) Pain (20 points) a) Gross anatomy (15 points)

No pain 20 Thickening only 15

Intermittent 16 5 degree angulation or 0.5 cm shortening

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With fatigue 12 10 degree angulation or rotation, 2 cm

shortening 09

Limits function 8 15 degree angulation or rotation, 3 cm

shortening 06

Constant or at exertion 4-0 Healed with considerable deformity

03

b) Walking capacity (20 points) Non-union or chronic infection 00

Same as before accident 20 b) Roentgenogram (15 points)

Mild restriction 16 Near normal 15

Restricted stair side ways 12 5 degree angulation or 0.5 cm

displacement 12

Use crutches or other 4-0 10 degree angulation or 1 cm

walking aids displacement 09

c) Joint movement (20 points) 15 degree angulation or 2 cm

displacement 06

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 Normal or 135 degrees 20 Union but with greater deformity,
spreading of condyles and osteoarthritis
03

Up to 100 degrees 16 Non-union or chronic infection

00

Up to 80 degrees 12

up to 60 degrees 8

Up to 40 degrees 4

Up to 20 degrees 0

d) Work capacity (10 points)

Same as before accident 10

Regular but with handicap 8

Alter work 6

Light work 4

No work 2-0

Excellent More than 85 points

Good 70 to 85 points
Fair 55 to 69 points
Poor Less than 55 points

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 5. REFERRENCES

1. Cory A Collinge and Donald A. Wiss Distal Femur Fractures,

Chapter 51 in Rockwood and Green Fractures in Adults, USA:
Lippincott Williams and Wilkins, 2010. 1719 pp

2. Smith, Wade R. 2007, Locking Plates TIPS and Tricks. The

Journal of Bone and Joint Surgery, 89:2298-2307

3. Heather A. Vallier, Theresa A. Hennesy, John K Sontich and

Brendan M Patterson, 2006 Failure of LCP condylar plate fixation
in the Distal Part of Femur- a Report of six cases. The Journal
of Bone and Joint Surgery, 88:846-853

4. Sommer C, Babst R, Muller M, Hanson B. 2004;Locking

compression plate loosening and plate breakage: a report of
four cases. J Orthop Trauma. 18:571-7.

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5. Trevor J. Lujan, Chris E. Henderson, Steven M. Madey, Dan C.
Fitzpatrick, J. Lawrence Marsh and Michael Bottlang 2010,
Locked Plating of Distal Femur Fractures Leads to
Inconsistent and Asymmetric Callus Formation. J Orthop
Trauma; 24:156162

6. Neer CS, Gratham SA, Shelton ML et al 1967 Supracondylar

fractures of adult femur. Journal of Bone and Joint Surgery, Vol. 49-
A, pg. 591-613

APPENDIX A

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 CONSENT FORM

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 APPENDIX A1
CONSENT FORM
Padmashree Dr. D. Y. Patil Medical College and Research Centre, Pimpri, Pune
Informed consent for the study A COMPARATIVE STUDY OF MANAGEMENT

OF FRACTURE SHAFT OF HUMERUS BY DYNAMIC COMPRESSION PLATE

AND INTERLOCK NAILING

.
I, ___________________________________, age ______ sex_____, give full
and free consent to participate in the study titled MANAGEMENT OF FRACTURE
SHAFT OF HUMERUS BY DYNAMIC COMPRESSION PLATE AND INTERLOCK
NAILING I have been explained the procedure and its complications in my own
language. I am giving this consent with a free mind and not by any pressure. I will not
hold the doctor, staff or hospital for any complications arising from this procedure. I
hereby allow Dr. ANKIT RAI/ Dr. ANIL SALGIA to proceed with the proposed modality
of treatment for my disease.

Date: Date:

Signature of Patient: Signature of witness:

Name of patient: Name of witness:

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 Appendix B
PROFORMA

The observation will be made from the data collected from the cases,
and will be tabulated as per the following

VITAL DATA
1. Name Reg.No.
2. Age/Sex
3. Occupation
4. Address
5. Date of admission Date of
Discharge:
6. Clinical data:
Presenting symptoms:
- Right/left lower limb & upper limb
- Any h/o of trauma
- Mode of injury
- H/o of pain
- Duration
- Swelling
- Click
- Any associated injury?
- Can weight bear fully ?
7. Past history:
8. Personal H/O:
9. Family H/o:

10. General examination :

11. Systemic examination :

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 12.Local Examination

Effusion
Swelling
Deformity
Any scar
Tenderness
Muscle wasting
Crepitus

13. Radiological findings

14. Site of Fracture

15. Operation notes

16. Complication

17. Duration of fractures healing

18. Results of Surgery

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