Radiological And Functional Outcome Of Dual Plating In Comminuted Intra-Articular Distal Femur Fractures

Abstract

INTRODUCTION Distal femur fractures, constituting 3-6% of femur fractures and 4% of all fractures, present significant challenges to orthopedic surgeons due to their complexity and potential for severe impairment. These fractures exhibit a bimodal age distribution, predominantly affecting young individuals (~20 years) and older women (~70 years). Fractures can be classified into extra articular, intra-articular unicondylar, and intra-articular bicondylar categories, with the AO/OTA classification system being widely used. Despite advances in surgical techniques and implants, intra-articular multifragmentary fractures, particularly AO type C2 and C3, remain difficult to treat effectively. AIM To evaluate the radiological and functional outcomes of dual plating in the treatment of comminuted intra-articular distal femur fractures (AO type C3). METHODS A prospective study was conducted at BLDE (Deemed to be University) Shri B. M. Patil Medical College, Hospital & Research Centre, Vijayapura, from August 2022 to November 2024. The study included 32 patients (17 males, 15 females) with comminuted distal femur intra-articular fractures. Patients were followed for a minimum of 6 months and a maximum of 12 months. Inclusion criteria were patients aged 18 and above with closed fractures who consented to treatment. Exclusion criteria included patients below 18, compound fractures, polytrauma, segmental fractures, and those medically unfit for surgery. The Neer score was used to assess outcomes. RESULTS Of the 32 patients, 56.3% sustained left-sided injuries and 43.8% right-sided injuries. The majority of injuries were due to road traffic accidents (75%), with the remainder from trivial falls (18.8%) and falls from height (6.3%). The modified swashbuckler approach was used in 78.1% of cases, while a dual incision approach was used in 21.9%. The mean Neer score improved from 51.69 at 6 weeks to 79.41 at 12 months, indicating a good to excellent outcome. Patients treated with the modified swashbuckler approach showed better functional outcomes. CONCLUSION Dual plating for comminuted intra-articular distal femur fractures (type C3) demonstrated favourable radiological and functional outcomes, with the modified swashbuckler approach yielding superior results. This study supports the efficacy of dual plating in enhancing fracture stabilization and promoting early mobilization. Further research with larger sample sizes and longer follow-up periods is recommended to validate these findings.