Original Research Article DOI: 10.18231/2395-1362.2018.0017 Indian Journal of Orthopaedics Surgery, January-March,2018;4(1):78-81 78 Surgical treatment of distal femur fractures using locking compression plate Tushar Agarwal 1,* , Kumar Saurav 2 , Siddharth Jadhav 3 , Ankur Kumar 4 , Manoj Pudari 5 1 Professor, 2-5 Resident, Dept. of Orthopaedics, Dr. D.Y. Patil Medical College, Pune, Maharashtra, India *Corresponding Author: Email: tushar.agarwal@rediffmail.com Abstract Distal femur fractures have been a challenge to the orthopaedic fraternity for long time. Improvement in implant material and design are expected to fetch better results in due course of time. Advent and use of locking compression plate has shown good results but requires more corroborative evidence to advocate its uses in different morphology of distal femur fracture. The present study was undertaken to evaluate clinical, radiological union and the complications associated with locking compression plate. Keywords: Distal femur fracture, Locking compression plate. Introduction Distal end femur fractures are not new to the orthopedic fraternity. It has been distinguished as an orthopedic issue all through history. These fractures constitute 6 to 7% of all femur fractures. 1 Bimodal distribution is noted on the basis of age and gender. High-energy distal femur fractures happen mostly in males in the age group of 15 to 50 years and mostly low-energy fractures happen in osteoporotic females aged >50 years. The commonest mode of injury due to high-energy trauma is motor vehicle accident (53%) and domestic fall happens to cause low-energy fractures. (33%). 2 Verifiably, these fractures tend to happen in patients with polytrauma and in elderly patients. These fractures are unstable fractures, so they are difficult to treat. Proximity to knee joint renders them vulnerable to limited range of motion. It additionally adds to different complications i.e. infection, fixed flexion deformity, knee stiffness. These complications make treatment of distal femoral fractures a troublesome undertaking for an orthopedic surgeon. 1 During 1960s, non-operative treatment strategies, for example, traction and cast bracing, delivered better outcomes over operative treatment in light of the absence of sufficient internal fixation devices. 3,4 With growing popularity of indirect reduction technique for re-establishing alignment of the limb, it has been noted to have increased rate of fracture healing and decreased rate of infection, decreased failure of fixation and reduced requirement of bone graft. Conservative modalities maybe used for fixation of fractures which are undisplaced or displaced minimally in a patient of old age and with limited functional requirement. Conservative treatment include skeletal traction or splints and mobilisation with partial weight bearing and eventually with cast or functional brace. X- rays are taken weekly to fortnightly in the initial six weeks to confirm whether reduction is maintained or not. Gradually patient is allowed partial to full weight bearing with joint mobilisation keeping in view the X- ray and clinical correlates of fracture union. Overall, conservative approach has not proven effective for displaced fractures. Butt et al 5 assessed operative versus non-operative treatment for displaced distal fractures of femur in the old age group in a RCT. This involved either randomizing the patients to surgical management using dynamic condylar screw (n=17) or giving skeletal traction for 6 to 8 weeks followed by functional bracing (n=19). Good to excellent outcome was noted in 53% of surgically- managed cases while 31% in conservatively managed cases. The patients who were conservatively managed showed higher chances of developing DVT (regardless of coumadin treatment), UTI and respiratory tract infections, bed sores, non-unions, malunions and pin tract infections. Average stay at hospital in case of conservatively managed cases was 9 weeks. Consequently, Butt et al 5 advocated surgical management of displaced distal femur fractures in older age group and conservative management only in cases where patients were unfit for surgery. Surgical intervention is treatment of choice for displaced and/or open fractures along with the ones having vascular injury. Aim of management incorporate anatomical restoration of the articulating surfaces, restoring lower extremity alignment, early knee range of motion, and early patient mobilization. Early treatment of these fractures normally incorporates an adequately padded long leg splint to minimize soft tissue compromise. In simple or compound fractures associated with high velocity injury, especially in polytrauma patients, a few specialists advocate use of knee-spanning external fixator until the point when definitive fixation is possible. 6-8 It helps to re-establish alignment, decreases chances of further soft tissue trauma and also enhances patient comfort and mobility. Calcaneum or proximal tibia can be used for skeletal traction as other alternatives to stabilize the fracture. Numerous choices can be availed for final fixation of these fractures and they comprise of external fixators, intramedullary nails, and plate osteosynthesis with open reduction and internal fixation or minimally