External fixator in treatment of distal femoral fracture in critically ill patients

  Backgroud  Distal femoral fractures combined with other critically ill patients often cannot tolerate open reduction and internal fixation of the fracture. If conservative treatment is performed, the articular surface cannot be reset, which will leave obvious sequelae. The external fixator has the characteristics of small surgical trauma, short operation time, and reliable fixation, but its clinical efficacy in the treatment of intra-articular fractures of the distal femur is still inconclusive.

  Objective  To investigate the clinical effect of external fixation on the treatment of distal femoral fractures in critically ill patients.

  Methods  A total of 18 patients with distal femoral fractures with other injuries were treated in our department from August 2015 to October 2019. All patients were treated with external fixator surgery. After operation, the patients were instructed to recover and exercise the knee joint, and all patients were followed up. The Hospital for Special Surgery (HSS) score was used to rank the function of knee joint at the last follow-up.

  Results  There were 16 males and 2 females with average age of 42 years (range: 21 - 75 years). The causes of fracture included falling (7 cases), traffic accident injury (9 cases), and injured by heavy objects dropping (2 cases). The AO/ASIF classification was used, with 2 cases of B-type fractures and 16 cases of C-type fractures. The time from injury to operation was 8-18 days, with an average of 14 days. Eighteen patients with fractures were followed up from 9 months to 18 months after surgery, with an average follow-up of 14 months. All fractures were healed. The healing time ranged from 3 months to 10 months, with an average of 5.2 months. According to the American Hospital for Special Surgery (HSS) scoring, 3 cases achieved excellent result, 11 cases were good, 3 cases were fair, and 1 case was poor. The excellent and good rate was 77.8%.

  Conclusion  External fixation for femoral intercondylar fractures is less invasive, with firm fixation and good postoperative function recovery, which is an ideal method for treating femoral intercondylar fractures with other parts of injury.