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Open biological reduction and a locking compression plate for distal femoral fractures: a review of 40 cases.

OBJECTIVE
To determine the clinical results of patients with comminuted fractures of the distal femur treated by open biological reduction using an indirect reduction technique and locking compression plate (LCP) without primary bone grafting.


MATERIAL AND METHOD
Prospective observation was conducted with 40 patients (24 males and 16 females), average age 48.7 years (range 20-81), with distal femoral fractures AO/OTA types A2 (5), A3 (17), C2 (8) and C3 (10) who were treated using an open indirect reduction technique and fixation with LCP between May 2010 and December 2013. Among the 40 patients, 28 were closed fractures and 12 were open fractures. Clinical results were evaluated using the Neer score six months after surgery. Follow-up periods ranged from 12 to 36 months (average 18.35).


RESULTS
Thirty eight (95%) of the fractures healed completely without a secondary procedure. The average time to union was 14.45 weeks (range 12-24). The average knee range of motion was 2° (0-5) to 110° (20-140). Two patients had an implant failure which required revision and secondary iliac bone grafting. There were no varus or valgus deformities, no limb shortening and no deep infections. Neer scores were excellent in 18 cases (45%), good in 14 (35%), fair in 6 (15%) and poor in 2 (5%). The mean Neer score was 83.60 (range 50-100).


CONCLUSION
The indirect reduction technique for the treatment of comminuted distal femoral fractures provides satisfactory results when combined with LCP fixation.