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. 2023 Jul-Sep;13(3):59-64.
doi: 10.4103/jwas.jwas_23_23. Epub 2023 Jun 27.

Management of Distal Femur Unicondylar Fractures by Calcaneal Buttress Plating: A Prospective Interventional Study

Dheeraj D Shekar  1 , Ramesh Chand Meena  1 , Shyoji Lal Sharma  1 , Krishnapriya T Vijayan  2 , Sachin Nayak  1 , Anushrey Singhal  1
Affiliations

Management of Distal Femur Unicondylar Fractures by Calcaneal Buttress Plating: A Prospective Interventional Study

Dheeraj D Shekar et al. J West Afr Coll Surg. 2023 Jul-Sep.

Abstract

Background: Unicondylar fracture of distal femur accounts for less than 1% of all femoral fractures. As conservative methods have shown substandard results, traditional surgical treatment includes open reduction and internal fixation by Herbert screws, cannulated screws, and conventional lateral locking plates. Though screw fixation has excellent results over long run, there is literature documenting the loosening and loss of articular congruency in elderly patients and in comminuted fracture patterns. Also, the traditional locking plates are precontoured to fit the lateral condyle, whereas there is no specific implant to fix the medial condylar fractures. The merit of the calcaneal plating is that it is easily moldable and can be used for either of the sides irrespective of fracture pattern.

Objectives: This study aimed to evaluate the clinical outcome of calcaneal plate (D-shape) fixation in distal femur unicondylar fractures.

Materials and methods: A total of 30 patients were studied, who met the inclusion criteria and consented to the surgery. After appropriate investigations, these patients were treated with calcaneal plating and were followed up postoperatively at 2 weeks, 1 month, 3 months, and 6 months for clinical evaluation.

Results: There was a gradual increase in the range of motion (ROM) with subsequent follow-ups. The overall mean ROM evaluated at 6 months was 108.46° ± 28.27° with P < 0.001 and was a statistically significant outcome. Also, the mean ROM for sagittal split fractures (~120°) was comparatively more than the coronally split fractures (~90°). The functional outcome assessed by Neer scoring showed excellent and satisfactory results in 24 (80%) patients, whereas the remaining six (20%) patients had poor results. None of the patients had nonunion, infection, or implant failure.

Conclusion: With no specific implant for isolated unicondylar fractures, the use of calcaneal plate in our study has shown promising results probably due to its low profile design reducing the soft-tissue irritation and wide area of bone coverage by the plate offering regions of intermittent fixation due to its spanning design, thereby promoting periosteal preservation and ultimately fracture union.

Keywords: Calcaneal plate; Herbert screws; Neer scoring; ROM; cannulated screws.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Functional Neer scoring
Figure 2
Figure 2
Anatomical Neer scoring
Figure 3
Figure 3
Plain radiograph of lateral unicondylar distal femoral fractureantero– posterior view
Figure 4
Figure 4
Plain radiograph of lateral unicondylar distal femoral fracturelateral view
Figure 5
Figure 5
3-D CT of lateral distal femoral condyle fracture
Figure 6
Figure 6
2-D CT of lateral distal femoral condyle fracture
Figure 7
Figure 7
3 month postoperative radiograph of the same patient showing fracture union in AP view
Figure 8
Figure 8
3 month postoperative radiograph of the same patient showing fracture union in lateral view
Figure 9
Figure 9
Patient exhibiting cross-legged sitting at 6-month follow-up
Figure 10
Figure 10
Patient flexing knee in the supine position at 6-month follow-up
See this image and copyright information in PMC

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