The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur

Sam Guk Park; Jeong Jae Moon; Oog Jin Shon

doi:10.12671/jkfs.2016.29.4.242

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Park, Moon, and Shon: The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur

Original Article

Journal of the Korean Fracture Society 2016; 29(4): 242-249.

Published online: 20 October 2016

DOI: https://doi.org/10.12671/jkfs.2016.29.4.242

The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur

Sam Guk Park, M.D., Jeong Jae Moon, M.D., Oog Jin Shon, M.D., Ph.D.

Department of Orthopedic Surgery, Yeungnam University College of Medicine, Daegu, Korea.

Address reprint requests to: Oog Jin Shon, M.D ., Ph.D. Department of Orthopedic Surgery, Yeungnam University Medical Center, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea. Tel: 82-53-620-3640·Fax: 82-53-628-4020, ossoj@med.yu.ac.kr

Received 6 July 2016 Revised 17 September 2016 Accepted 21 September 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma.

Materials and Methods

Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated.

Results

The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores.

Conclusion

The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

Keywords: Distal femur fracture, Intra-articular fractures, Post-traumatic osteoarthritis, Mid-term

Figures and Tables

Fig. 1

A 46-year-old female with metaphyseal simple and complete articular fracture with coronal plane fracture, who was injured by a fall (AO/OTA 33-C3). (A) Anteroposterior and lateral radiograph of the right distal femur fracture. (B) Computed tomography. (C) Radiographs, obtained immediately operatively, show an internal fixation. (D) Radiographs obtained at 10 months after surgery show complete bony union at the fracture site. (E) Radiographs obtained at 14 months after surgery show a device removal status. (F) Radiographs obtained at 4 years after surgery show normal alignment and no post-traumatic osteoarthritis progression.

Table 1

Radiographic and Clinical Results between the AO/OTA 33-B and C Groups

Variable	Group		p-value
Variable	AO/OTA 33-B	AO/OTA 33-C	p-value
Radiographic results
Bone union time (wk)	12.4 (10–16)	20.2 (16–28)	0.003
Axial alignment
AA of the femur & tibia (°)	5.4	5.1	0.542
mLDFA (°)	89.3	89.4	0.326
Clinical results
Range of motion (°)	136.0	125.5	0.018
Knee Society score
Knee score	93.0	84.0	0.017
Function score	91.0	83.3	0.028

AA: Anatomic axis, mLDFA: Mechanical lateral distal femoral angle.

Table 2

Selected Variables in Accordance with the Result of the Stepwise Method of Multiple Logistic Regression (Dependent Variable=Post-Traumatic Osteoarthritis Change)

Variable	Coefficients (β)	p-value	Odds ratio
Classification	0.526	0.001	15.750
Coronal plane fracture	0.449	0.004	13.772
Age	−0.356	0.023	4.294
Alignment	0.228	0.188	0.992
Range of motion	0.301	0.282	1.857
Knee Society score
Knee score	0.186	0.262	1.671
Function score	0.242	0.143	1.825

Table 3

Comparison of Pain at the Fracture Site Pain between Short Term and Mid-Term

Fracture site pain	F/U 1 year	F/U >3 years
None	8 (38.1)	8 (38.1)
Mild (occasional)	3 (14.3)	8 (38.1)
Mild (stairs only)	5 (23.8)	2 (9.5)
Mild (walking and stairs)	2 (9.5)	1 (4.8)
Moderate (occasional)	2 (9.5)	2 (9.5)
Moderate (continual)	1 (4.8)	0
Severe	0	0

Values are presented as number (%). F/U: Follow-up.

Table 4

Comparison of the Knee Society Score between Short-Term Result and Mid-Termz

Variable	Knee score		Function score
Variable	F/U 1 year	F/U >3 years	F/U 1 year	F/U >3 years
Excellent (80–100)	12 (57.1)	15 (71.4)	13 (61.9)	15 (71.4)
Good (70–79)	3 (14.3)	3 (14.3)	3 (14.3)	2 (9.5)
Fair (60–69)	4 (19.1)	3 (14.3)	3 (14.3)	3 (14.3)
Poor (<60)	2 (9.5)	0	2 (9.5)	1 (4.8)
Satisfaction	15 (71.4)	18 (85.7)	16 (76.2)	17 (80.9)

Values are presented as number (%). F/U: Follow-up.

Notes

^{Financial support} None.

^{Conflict of interest} None.

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