الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Distal femoral fractures are serious injuries and represent a real challenge as regards their management. Treatment of such fractures has been controversial as various treatment modalities are available.
The aim of the study was to assess the results of treatment of distal femoral fractures by retrograde intramedullary nailing versus minimal invasive locking compression plates. This was retrospective study that included20 patients with distal femoral fractures divided into two groups; group A treated by RGN and group B treated by minimal invasive LCP.
In group A the mean age of patients was 40.9 (28-60) years. Eight patients were males (80%) and 2 patients were females (20%). seven patients (70.0%) had their fractures due to severe trauma (RTA or FFH) and 3 patients(30.0%) due to mild to moderate trauma (falling down). All of them (100%) had type A fracture according to AO classification. The mean time before surgery was 5.4 days.
In group B the mean age of patients was 41.7(24-52) years. Seven patients were males (70.0%) and 3 patients (30.0%) were females. Eight patients (80%) had their fractures due to severe trauma and 2 patients (20%) due to mild to moderate trauma. 7 patients (70.0%) had type A fracture and 3 patients (30.0%) had type C fracture according to AO classification. The mean time before surgery was 3.4 days.
Every patient in this series was subjected to clinical and radiological examination in order to collect the data needed for analysis of the results. Every patient was examined clinically for the following data: limping, pain, evidence of infection, deformities, limb length discrepancy and range of knee motion. Anteroposterior and lateral views of the lower femur and the
knee were done for every patient at the time of follow up, in addition to the preoperative and immediate postoperative x-rays. Assessment of the union, displacement, angulations and implant failure were done by observing these x-rays.
The results were assessed both clinically and radiologically by modified Olerud scale.(33, 85)
In group A: 2 patients (20.0%) had excellent result, 3 patients (30.0%)
had good results, 3 patients (30.0%) had fair results and 2 patients (20.0%) had poor results.
In group B: one patient (10.0%) had excellent result, 4 patients (40.0%) had good results, four patients (30.0%) had fair results and 2 patients (20.0%) had poor result.
There was no significant statistical difference between two groups regarding age, sex, side affected, time before surgery, mechanism of injury, time of union, shortening, smoking, walking capacity, alignment, work capacity and final score. There was significant statistical difference regarding pain and joint movement.Retrograde nailing provided favorable intramedullary stability and stable callus, and may be successfully implanted in segmental fractures of the lower extremity. Persistent knee pain and inability to use in type C fractures are the main limiting factors of retrograde nail. LCP was associated with less morbidity in terms of persistent knee pain and better range of movements than retrograde nailing. Locked plating may be utilized for all distal femur fractures including type C fractures and osteoporotic fractures.
The complications encountered in this study were joint stiffness, shortening and knee pain.