الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Supracondylar fractures of the femur are very serious injuries. For a long time they were considered difficult to heal and often led to a degree of disability. These difficulties become greater when they are associated with elderly patients who present with a high degree of osteopenia. Surgical methods involving open reduction and internal fixation have been advocated using various implants including angle blade plates.
Fixation with a modified supracondylar plate and a lag screw has been described, too. During the last few years, new implants have been developed to allow less traumatic operative techniques by means of minimally invasive surgery. A new method of retrograde unreamed supracondylar femoral nail based on the AO unreamed femoral nail was used recently, especially in elderly patients. However, surgical treatment by means of internal fixation presents several difficulties, particularly in elderly patients with thin cortical metaphyseal and osteoporotic bone.
The incidence of elderly population sustaining distal femoral fractures had been increasing in the last two decades with a changing epidemiological pattern as regards female to male ratio (2:1). Distal femoral fractures compromise 3–6% of all femoral fractures.
The most common mechanism of injury is low-energy trauma following a simple fall in this osteoporotic population. Being comparable to proximal femoral fractures regarding high mortality and comorbidity, inadequate number of studies addressed the best fixation protocol, especially in this age group.
Supracondylar fractures can cause delayed union or nonunion that requires reoperation, regardless of the internal fixation method used during surgery, and can lead to deep infection, implant failure, and malunion. In particular, supracondylar fractures of the femur, especially in the elderly, mainly occur in patients with severe osteoporosis. As the distal fracture fragment is too small to obtain sufficient fixation, nonunion or irregular union and considerable bleeding occur, thereby increasing the mortality risk.
The aim of this study was to systematically review the literature regarding Fixation modalities in supracondylar fracture femur in geriatric age patients with an emphasis on recent advances.
In this systematic review, we searched Medline (Ovid), PubMed, Cochrane library, and empase from Jan 2000 to July 2020. The search retrieved 779 unique records. We then retained 13 potentially eligible records for full-texts screening. Finally, 10 studies were included.
The main findings of the study revealed that:
425 cases were included with mean age 76.7 years old and m\f was 102\323
As regard OTA-classification type A(148),type B(45),type C(77), regarding fixation type was either single\double plate, locking plates , minimally invasive plates , Retrograde nailing, Screws, wires ,cables, ORIF by Angle-stable plates.
Cerclage wiring as an adjunct was used in 34 cases , In 11 cases bone augmentation with cement was performed due to osteopenia
Mean follow up was 22.7 months , mean operative time was 123.4 minutes , mean blood loss was 423.2 ml , 1 cases admitted to ICU and mean hospitalization was 15.9days
Mean ROM post operation was 105 , mean flexion, extension was 23.1°,0.7° respectively , mean time achieved mobilization\days was 7.5
77 cases had full weight bear,19 had partial weight bearing and 36 cases had no weight bear
77 cases had full weight bear,19 had partial weight bearing and 36 cases had no weight bear
Mean Modifed RUST score pre − 3 changes to 10.1 post operation , mean Lysholm knee score post was 65.3, mean Knee society score was 83.5 and mean HSS knee score was 85.1
Mean time to union was 16.92 weeks in 313 cases achieved union , mal-union in 4 cases and non-union in 10 cases
A total of 66 complications was founded in form of infection 17 cases , pneumonia in 3 cases , fat embolism in 2 cases , deep vein thrombosis in 1 case , postoperative delirium in 1 case and persistent pain in 4 case
Impaired wound healing in 2 cases, prominent distal screw in 1 case , secondary dislocation of the tibia in 1 case , bleeding in 1 case , and mortality was in 32 case
failure founded in 1 case and inter implant fracture in 1 case
As regard secondary procedures. 1 revision operation was performed for metal implant failure, 10 irrigation and debridement were performed on wound infection, for non-union 3 performed only bone grafting, 2 cases added a plate on the medial side of the femur (one case also used bone grafting), 2 cases left an existing plate with replacing the position of the screw, 2 cases replaced with a long plate, and 1 case was shortened the fracture site and performed bone grafting and plate fixation
Based on our findings, we recommend for further studies on larger sample size and larger scale to emphasize our conclusion.
CONCLUSION
The current systematic review suggested that the surgical fixations with different fixation techniques were all safe and effective in the treatment of supracondylar fracture femur in geriatric age patients, however minimally invasive treatments were recommended among this age group. Geriatric distal femur fractures present similar challenges to management as geriatric hip fractures and an understanding of medical co-management and early appropriate surgery through the development of a distal femur fracture program similar to those developed for hip fractures warrants consideration.
The best outcome was found in Retrograde femoral nailing, but this study was limited by small sample size.
RECOMMENDATIONS
Further randomized studies on large sample and on large scale with longer follow up to differentiate between different modalities of treatment of supracondylar femur fracture in elderly patients.
We recommend for that Geriatric medical co-management, appropriately early surgical intervention, and use of fixation to allow for mobilization are central to hip fracture programs and merit consideration in the treatment of geriatric distal femur fractures.
Additionally, literature is beginning to show mortality benefits to early treatment of distal femur fractures in the elderly.
A social worker should be involved to ensure that the patient’s home environment is safe and that the patient has support services. The recovery is often slow, and many patients need pain control; hence, a pharmacist may be helpful to educate the patient on modes of pain management.
Open communication between the team members is vital to improving patient outcomes. These interprofessional team dynamics can improve patient outcomes