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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE , KARNATAKA

SYNOPSIS

OF

DISSERTATION

“STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMUR FRACTURE USING LOCKING COMPRESSION PLATE”

Submitted by

DR . SOMNATH MACHANI

M.B.B.S.

DEPARTMENT OF ORTHOPAEDICS

VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH CENTER,

WHITEFIELD, BANGALORE.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,

BANGALORE

ANNEXURE –II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

|1 |Name of the candidate and address |DR. SOMNATH MACHANI |

| | |DEPARTMENT OF ORTHOPAEDICS ,VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE,|

| | |WHITEFIELD , BANGALORE. |

|2 |Name of the institution |VYDEHI INSTITUTE OF MEDICAL SCIENCES & RESEARCH CENTRE, WHITEFIELD , BANGALORE |

|3 |Course of study and subject |M.S. ORTHOPAEDICS |

|4 |Date of admission to the course |24th April, 2010. |

|5 |Title of the topic |STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMUR FRACTURE USING LOCKING COMPRESSION |

| | |PLATE. |

6.BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR THE STUDY:

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

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

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

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 to know the rate of complications associated with the devices.

6.2 REVIEW OF LITERATURE:

Locked plating or angular stability was originally described by Wolter in 1927 and Reinhold in 1931. 2 Studies till the 1960’s revealed non operative treatment for distal femur fractures were better than open reduction.

LISS or Less invasive stabilization system developed in the 1970's used unicortical locking screw.

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.

First clinical results of the Locking plate in March 2000 on 18 femoral fractures, 57 tibial, 45 humerus, 19 radius showed a 86% healing. 3

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.4

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

6.3 OBJECTIVES OF STUDY:

1. To study the union rates with locking compression plates

2. To study the clinical outcome associated with this treatment modality.

– Knee Range of movements

– pain relief

– return to normal activities and work.

7. MATERIAL AND METHODS:

7.1 SOURCE OF DATA:

The study will be conducted on patients of distal femur fracture treated by locking compression plate in Department of Orthopaedics, Vydehi Institute of Medical Sciences and Research Centre, Whitefield, Bangalore, during the study period December 2010 to June 2012

Sample size – 20.

7.2 METHOD OF COLLECTION OF DATA:

We will prospectively follow up 20 cases of Distal Femur fractures treated with LCP during 18 month period in our hospital. Patients with distal femur fracture are admitted and examined according to protocol both clinically and radiologically. Fracture care will be provided by trained Traumatologist at our hospital. They will be followed up regularly by clinical examination, Neers' scoring and X rays taken immediately after operation, at 6 weeks, 12 weeks and 24 weeks after surgery.

INCLUSION CRITERIA:

All patients with distal femur fractures treated with LCP

All skeletal mature patients(>18years)

Patients with osteoporosis.

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

Patients willing to give consent

EXCLUSION CRITERIA:

Patients of age less than 18 yrs

Open fractures type III B and C

Pathological Fractures

Associated tibial plateau fractures

Non union and Delayed union

STATISTICAL ANALYSIS- Patients will be evaluated by Neers'.Scoring System and results will be analyzed by Proportions.

7.3 Does the Study require any investigation or intervention to be conducted on the patients or animals, if so please describe briefly

YES

The investigations done in the cases selected for the study are :

1. Routine Blood investigations

2. X ray femur with knee joint - Anterior posterior view.

3. x-ray femur with knee joint – lateral view

4. C.T.scan and 3 D reconstruction if required

5. Immediate Post operative X ray and at 6 weeks, 12 weeks and 24 weeks after surgery

6. Open Reduction and Internal Fixation with wound debridement and Bone grafting if necessary

SCORING SYSTEM

Neers scoring system 6

|Functional (70 points) |Anatomical (30 points) | |

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

|No pain |20 |Thickening only 15 |

| Intermittent |16 |5 degree angulation or 0.5 cm shortening |

| | |12 |

|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 walking aids |4-0 |10 degree angulation or 1 cm displacement |

| | |09 |

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

| |06 |

|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

7.4 Has ethical clearance been obtained from the institution:

Yes, copy enclosed.

8. LIST OF REFERENCES

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

Smith, Wade R. 2007, “Locking Plates – TIPS and Tricks.” The Journal of Bone and Joint Surgery, 89:2298-2307

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.

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

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; 24:156–162

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

|9 |Signature of the candidate | |

| | |Fractures of the Distal Femur are common due to increased Road traffic accidents and |

|10 |Remarks of the Guide |fall from height because of increased constructional activities. These Fractures are |

| | |quite disabling. Hence surgical management of these fracture by Locking Compression |

| | |Plate and to study the outcome is very essential. |

| | | |

|11 |11.1 Name and Designation of the Guide |Dr .MURALIDHAR.N |

| | |B.Sc, M.B.B.S, M.S.D.Ortho |

| | |Professor and Head of the Department, |

| | |Department of Orthopaedics,VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH |

| | |CENTRE,WHITEFIELD, BANGALORE. |

| |11.2 Signature | |

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| |11.3 Head of the Department |Dr .MURALIDHAR.N |

| | |B.Sc, M.B.B.S, M.S.D.Ortho |

| | |Professor and Head of the Department, |

| | |Department of Orthopaedics,VYDEHI INSTITUTE OF MEDICAL SCIENCES AND RESEARCH |

| | |CENTRE,WHITEFIELD, BANGALORE. |

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| |11.4 Signature | |

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|12. | | |

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| |12.1 Remarks of the Principal | |

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| |12.2 Signature | |

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