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Abstract
RÉSUMÉ
Introduction. L’objectif de notre étude était de décrire les résultats radiologiques et fonctionnels du traitement des fractures de l’extrémité distale du fémur par plaque condylienne dans notre pratique. Matériels et méthodes. Notre étude prospective transversale a été menée de janvier 2018 à décembre 2023 au service de Traumatologie-Orthopédie du CHU de Brazzaville. Elle a concerné 44 patients opérés d’une fracture de l’extrémité distale du fémur par plaque condylienne, âgés de plus de 17 ans et suivis pendant au moins six mois. Les fractures ouvertes type 2 et 3 de Cauchoix-Duparc, et les fractures pathologiques, ont été exclues. Les critères de la SOFCOT de 1988 ont été utilisés pour l’évaluation thérapeutique. Résultats. Tous les patients ont consolidé après un délai moyen de 4,56 mois (extrêmes 3 à 8 mois). La consolidation était anatomique dans 38 cas (86,36 %) et compliquée d’un recurvatum de plus de 10° dans 6 cas (13,64 %). Trente-quatre patients (77,28 %) avaient une fonction normale et 8 patients (18,18 %) étaient limités à 90° de flexion. Les critères SOFCOT ont été jugés très bons chez 31 patients (70,46 %). Les complications du traitement étaient une vis intra-articulaire dans trois cas (6,82 %) et une infection du site opératoire dans deux cas (4,54 %). Conclusion. La plaque condylienne donne de bons résultats radiologiques et fonctionnels. Le résultat dépend du respect des principes de stabilisation osseuse et des propriétés de la plaque condylienne.
ABSTRACT
Introduction. The aim of our study was to describe radiological and functional outcomes of condylar plate treatment of distal femoral end fractures in our practice. Materials and methods. Our prospective cross-sectional study was conducted from January 2018 to December 2023 in the Traumatology-Orthopaedics Department of the Brazzaville University Teaching Hospital. It involved 44 patients operated on for a fracture of the distal end of the femur, using a condylar plate, aged over 17 years and followed up for at least six months. Cauchoix-Duparc type 2 and 3 open fractures and pathological fractures were excluded. The 1988 SOFCOT criteria were used for therapeutic evaluation. Results. All patients consolidated after an average period of 4.56 months (range 3 to 8 months). Consolidation was anatomical in 38 cases (86.36%) and complicated by recurvatum of more than 10° in 6 cases (13.64%). Thirty-four patients (77.28%) had normal function and 8 patients (18.18%) were limited to flexion less than 90°. SOFCOT criteria were judged to be very good in 31 patients (70.46%). The complications of treatment were an intra-articular screw in three cases (6.82%) and a surgical site infection in two cases (4.54%). Conclusion. Surgical treatment using condylar plate provides good radiological and functional results. The outcome depends on sound compliance with the principles of bone stabilization and the properties of the condylar plate.
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References
- Stover M. Distal femoral fractures current treatment results and problems. Injury. 2001;32 suppl 3:SC3–S13.
- Martinet O, Cordey J, Harder Y, Maier A, Buhler M, Barraud GE. The épidemiology of fractures of the distal femur. Injury. 2000:31 Suppl 3:C62–3.
- Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. Acta Orthop Scand. 1982;53(6):957–62.
- Marius M, Bouhelo-Pam K, Ohoya Etsaka TO, Ngatsé-Oko A, Moyikoua A. Results of distal femur fractures managed by blade plate 95° at Brazzaville teaching hospital. Int J Res Orthop. 24 oct 2018;4(6):810.
- Batchlor E, Heal C, Kimberly Haladyn J, Drobetz H. Treatment of distal femur fractures in a regional Australian hospital. World J Orthop. 2014;5(3):379 -85.
- Foster MC, Komarsamy B, Davison JN. Distal femoral fractures a review of fixation methods. Injury. 2006;37:97-108.
- Chun–Jui Weng, Chi-Chuan Wu, Kuo-Fun Feng et al. Comparison of supra-intercondylar and supracondylar femur fractures treated with condylar buttress plates. BMC Musculoskelet Disord 2016;17:413.
- Ehlinger M, Ducrot G, Adam P, Bonnemet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol: Surg Res. 2013;99:353–60.
- Higgins T. Distal Femoral Fractures. J Knee Surg. 20 janv 2010;20(01):56‑66.
- Cauchoix J, Duparc J, Boulez P. Traitement des fractures ouvertes de jambe. Mém Acad Chir. 6 nov 1957;83 (1):811-22.
- Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma. janv 2018;32(1):S1‑10.
- Asencio G. Fractures of the distal femur. Round table of the SOFCOT. Rev Chir Orthop 1988;75(suppl.1):168-83.
- Hoffmann MF, Jones CB, Sietsema DL, Tornetta P, Koenig SJ. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. Journal of Orthopaedic Surgery and Research 2013, 8:43.
- WengCJ,Wu CC, Feng KF, Tseng IC, Lee PC, Huang YC. Comparison of supraintercondylar and supracondylar femur fractures treated with condylar buttress plates. BMC Musculoskeletal Disorders 2016; 17:413.
- Massoud EIE. Fixation of distal femoral fractures: Restoration of the knee motion. Ulus Travma Acil Cerrahi Derg. 2015 ;21(3) :197-203.
- Liang B, Ding Z, Shen J, Zhai W, Kang L, Zhou L, et al. A distal femoral supra-condylar plate: biomechanical comparison with condylar plate and first clinical application for treatment of supracondylar fracture. Int Orthop. 2012;36(8):1673-9.
- Pascarella R, Bettuzzi C, Bosco G, Leonetti D, Dessì S, Forte P, et al. Results in treatment of distal fractures using polyaxial locking plate. Strategies. Trauma Limb Reconstr. 2014;9(1):13-8.
- Sîrbu PD, Asaftei R, Petreuæ T, Lupaæcu C, Puha B, Luncã S. Transarticular Approach and Retrograde Plate Osteosynthesis (TARPO) Using Implants with Angular Stability – A Series of 17 Cases of Complex Distal Femoral Fractures Type C3/AO. Chirurgia 2014 ;109(2) :233-7.
- Virk JS, Garg SG, Gupta P, Jangira V, Singh J, Rana S. Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures. Journal of Clinical and Diagnostic Research. 2016 ;10(10): RC01-RC05.
- Kim J, Kang SB, Nam K, Rhee SH, Won JW, Han HS. Retrograde intramedullary nailing for distal femur fracture with osteoporosis. Clin Orthop Surg. 2012;4(4):307-12.
- Nester M, Borrelli J. Distal femur fractures management and evolution in the last century. International Orthopaedics (SICOT). août 2023;47(8):2125‑35.
- Nayak RM, Koichade MR, Umre AN, Ingle MV. Minimally invasive plate osteosynthesis using a locking compression plate for distal femoral fractures. J Orthop Surg 2011;19(2):185-90.
- Handolin L, Pajarinen J, Lindahl J, Hirvensalo E. Retrograde intramedullary nailing in distal femoral fractures–Results in a series of 46 consecutive operations. Injury Int J. 2004;35:517–22.
- Sery BJLN, Kouassi KJE, YAO LB, M’Bra KI, Kouassi AA, Michel K. Fractures du fémur distal : Résultats des traitements. Rev int sc méd 2019;21(4):342-5
References
Stover M. Distal femoral fractures current treatment results and problems. Injury. 2001;32 suppl 3:SC3–S13.
Martinet O, Cordey J, Harder Y, Maier A, Buhler M, Barraud GE. The épidemiology of fractures of the distal femur. Injury. 2000:31 Suppl 3:C62–3.
Kolmert L, Wulff K. Epidemiology and treatment of distal femoral fractures in adults. Acta Orthop Scand. 1982;53(6):957–62.
Marius M, Bouhelo-Pam K, Ohoya Etsaka TO, Ngatsé-Oko A, Moyikoua A. Results of distal femur fractures managed by blade plate 95° at Brazzaville teaching hospital. Int J Res Orthop. 24 oct 2018;4(6):810.
Batchlor E, Heal C, Kimberly Haladyn J, Drobetz H. Treatment of distal femur fractures in a regional Australian hospital. World J Orthop. 2014;5(3):379 -85.
Foster MC, Komarsamy B, Davison JN. Distal femoral fractures a review of fixation methods. Injury. 2006;37:97-108.
Chun–Jui Weng, Chi-Chuan Wu, Kuo-Fun Feng et al. Comparison of supra-intercondylar and supracondylar femur fractures treated with condylar buttress plates. BMC Musculoskelet Disord 2016;17:413.
Ehlinger M, Ducrot G, Adam P, Bonnemet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol: Surg Res. 2013;99:353–60.
Higgins T. Distal Femoral Fractures. J Knee Surg. 20 janv 2010;20(01):56‑66.
Cauchoix J, Duparc J, Boulez P. Traitement des fractures ouvertes de jambe. Mém Acad Chir. 6 nov 1957;83 (1):811-22.
Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium—2018. Journal of Orthopaedic Trauma. janv 2018;32(1):S1‑10.
Asencio G. Fractures of the distal femur. Round table of the SOFCOT. Rev Chir Orthop 1988;75(suppl.1):168-83.
Hoffmann MF, Jones CB, Sietsema DL, Tornetta P, Koenig SJ. Clinical outcomes of locked plating of distal femoral fractures in a retrospective cohort. Journal of Orthopaedic Surgery and Research 2013, 8:43.
WengCJ,Wu CC, Feng KF, Tseng IC, Lee PC, Huang YC. Comparison of supraintercondylar and supracondylar femur fractures treated with condylar buttress plates. BMC Musculoskeletal Disorders 2016; 17:413.
Massoud EIE. Fixation of distal femoral fractures: Restoration of the knee motion. Ulus Travma Acil Cerrahi Derg. 2015 ;21(3) :197-203.
Liang B, Ding Z, Shen J, Zhai W, Kang L, Zhou L, et al. A distal femoral supra-condylar plate: biomechanical comparison with condylar plate and first clinical application for treatment of supracondylar fracture. Int Orthop. 2012;36(8):1673-9.
Pascarella R, Bettuzzi C, Bosco G, Leonetti D, Dessì S, Forte P, et al. Results in treatment of distal fractures using polyaxial locking plate. Strategies. Trauma Limb Reconstr. 2014;9(1):13-8.
Sîrbu PD, Asaftei R, Petreuæ T, Lupaæcu C, Puha B, Luncã S. Transarticular Approach and Retrograde Plate Osteosynthesis (TARPO) Using Implants with Angular Stability – A Series of 17 Cases of Complex Distal Femoral Fractures Type C3/AO. Chirurgia 2014 ;109(2) :233-7.
Virk JS, Garg SG, Gupta P, Jangira V, Singh J, Rana S. Distal Femur Locking Plate: The Answer to All Distal Femoral Fractures. Journal of Clinical and Diagnostic Research. 2016 ;10(10): RC01-RC05.
Kim J, Kang SB, Nam K, Rhee SH, Won JW, Han HS. Retrograde intramedullary nailing for distal femur fracture with osteoporosis. Clin Orthop Surg. 2012;4(4):307-12.
Nester M, Borrelli J. Distal femur fractures management and evolution in the last century. International Orthopaedics (SICOT). août 2023;47(8):2125‑35.
Nayak RM, Koichade MR, Umre AN, Ingle MV. Minimally invasive plate osteosynthesis using a locking compression plate for distal femoral fractures. J Orthop Surg 2011;19(2):185-90.
Handolin L, Pajarinen J, Lindahl J, Hirvensalo E. Retrograde intramedullary nailing in distal femoral fractures–Results in a series of 46 consecutive operations. Injury Int J. 2004;35:517–22.
Sery BJLN, Kouassi KJE, YAO LB, M’Bra KI, Kouassi AA, Michel K. Fractures du fémur distal : Résultats des traitements. Rev int sc méd 2019;21(4):342-5