Distal Femur Fracture, Geriatrics
Conditions
Keywords
Distal femoral fractures, Double plating, Distal femoral replacement, Geriatrics
Brief summary
The aim of this study was to compare the functional and radiological outcomes of fixation by using double plating technique versus replacement using distal femur tumor prothesis as a primary management for the distal femoral fractures in geriatric patients. The hypothesis was that the distal femoral replacement will yield better functional outcome and earlier rehabilitation and return to pre-injury level of activity.
Detailed description
Geriatric distal femoral fractures represent a major challenge for the orthopedic surgeons, to the present days still there is no definite algorithm or specific guidelines that can be used accurately in the management of these fractures. Unlike hip fractures however, there is no widely accepted treatment algorithm or standard of care. The surgical treatment of distal femoral fractures depends on both patient and fracture characteristics. Options include conservative treatment, open reduction internal fixation, intramedullary nails, or recently distal femoral replacement. There is currently a move towards distal femoral replacement (DFR) for these complex fractures which has the potential benefit of allowing early weight bearing, and therefore aiming to prevent complications associated with immobility and non-union. Using distal femoral replacement had yield good results in small case series, as it allows immediate full weightbearing, eliminate the risk of nonunion and may provide greater satisfaction scores. However, DFR has its own risks, most notably deep infection, and loosening. While a DFR is more costly compared with fixation plates and nails, the initial increased cost may be outweighed by faster rehabilitation and return to the patient's usual place of residence. In the study, the investigators are aiming to compare the functional and radiological outcomes of fixation by using double plating technique versus replacement as a primary management for the geriatric distal femoral fractures.
Interventions
PROCEDUREdouble plating
open reduction and internal fixation by using lateral and medial plates.
PROCEDUREDistal femoral replacement
excision of the distal part of femur and replacement with distal femoral prosthesis
Sponsors
Amr Gamaleldin Mahmoud Khalil Gendya
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
60 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* AO 33 A3 and 33 C fractures * Age group ≥ 60 years * Closed fractures * Neurovascular intact
Exclusion criteria
* Open fractures * Non ambulant patients * Patients with peripheral neurovascular diseases * Peri-prosthetic fractures * Associated other orthopedic injuries * Poly-traumatized patients * Pathological fractures
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| change in Knee Society Score | 1 month, 6 month and 12 month | the score has two-part, knee and function parts. The score is graded from 0 to 100 in each domain with 100 is the best outcome and 0 is the worst. The knee part assesses the range of motion, pain, and alignment of the joint while the function part assesses walking, stairs and usage of walking aids. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| change in Knee range of motion | 1 month and 12 month | Assessment of range of motion of the knee which has normal range from 0 to 135 |
| Postoperative complications | form first day to 12 month | Assessment of postoperative complications either early or late complications |
| Reoperation rate | form first day to 12 month | Recording the need for secondary operation for a cause related to the fracture union, postoperative complications, or prothesis problems. |
| Operative time | At the operation | Recording of the operative time from the time of incision to the time of skin closure |
Countries
Egypt
Outcome results
None listed