الفهرس 
Anatomy of the distal femurOnly 14 pages are availabe for public view
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Abstract
The study was conducted on 20 patients with distal femoral fractures
to have distal femoral biological plate. The AO/OTA classification was used
to grade the fractures and we investigate the advantage and complication of
plate in fixation of distal femur fractures AO type A, C1 and. Operative
time, wound healing, early mobilization, knee range of motion, pain, weight
bearing callus formation, time of healing, deformity and shortening ,
incidence of reoperation and complications.
The primary goal of MIPO techniques treatment of fractures of the
distal femur is to provide anatomic reduction with stable internal fixation to
the intra-articular part of fracture and to achieve union with bridging callus
through relative stability for metaphyseal-diaphyseal part of fracture to allow
for early active range of motion and decrease the rate of complications. This
is more challenging when dealing with elderly patients having comorbidities
both local (e.g. osteoporosis and osteoarthritis), and systemic illness.
Deficits were predominantly related to the increased age of the patients and
concomitant limitations of the locomotor system.
Distal femoral locking plates offer more fixation versatility without an
apparent increase in mechanical complications or loss of reduction. Fracture
treatment was performed by way of a minimally invasive approach, thus
conserving as far as possible any intact soft tissue and fragment vascularity.
Use of bicortical screws is essential in osteoporotic fractures angulations
and shortening In this study 20 cases was done; their age range from 23 – 77 years.
Only 19 cases completed the follow-up. 1 patient (5%) lost follow up due to
death in 20th postoperative day due to multimorbidities not related to
original injury. And their results after analysis as follow in 14 cases union
occurred (73.68%) 3 cases showed delayed union. The first case iliac bone
graft combined with osteoconductive bone substitute was done (with
excellent healing clinical and radiological at three months). The other two
patients also underwent bone graft on the 6th month due to delayed
appearance and decreased amount of callus. 1 case of deep infection in the
early postoperative period, debridement, irrigation, was done in the 3rd week
postoperative. Wound improved however CRP was 13 and not increasing,
and got nonunion. The patient refused any further surgery.2 cases of
nonunion the 1st one due to loss of reduction, patient managed by removal of
plate and fixed by buttress plate finally TKR was done. The other case due
to deep infection (the same patient of deep infection).
Based on this study; and compared to other fixation modalities which
include distal femoral nail (DFN), dynamic condylar screw (DCS), and
angled blade plate (ABP), plates inserted using MIPO techniques showed
more favorable outcome, less surgical morbidities, better rehabilitation.
The treatment of distal femur fractures has historically been
associated with a high incidence of complications, including non-union or
delayed union, malalignment of the femur, infections of bone and soft
tissues, chronic pain and decreased range of motion and function of the knee
joint. The MIPO technique avoid extensive open surgical procedures in order to reduce damage to blood supply of bone and surrounding tissues thus
facilitating better healing.
A surgeon should realize his comfort level with the injury and
familiarization of implant choices. More similar studies are needed for
results confirmation.
On the basis of the finding of this study and other many studies have
concluded (132,133) that MIPO technique preserves most of the osseous
vascularity and fracture hematoma thus providing for a more biological
repair. There is rapid fracture consolidation due to preserved vascularity.
There are fewer incidences of delayed union and non-union. There is a
decreased need for bone grafting and incidence of infection is less due to
limited exposure.
We need randomized comparative study between different methods of
biological fixation of distal femoral fracture specially plate, IM and EF.