Treatment of the distal femur open fractures

Abstract

The aim: Presenting the surgical treatment results in 10 patients with distal femur open fractures with analysis of management a case of septic complication. Materials and methods: The analyze of surgical treatment results in 10 patients was performed. Gustillo-Andersen classification was used: type I – 1 case, type II – 4 cases, type IIIA – 5 cases, type IIIB – 2 cases (2 pacients with bilateral fractures). In all patients the first stage consisted of: primar surgical debridment with applying skeletal traction through the tibial tuberosity with leg "in empty" - 6 cases; stabilization with external fixators- 4 cases; "limited" fixation of joint surface with screws and stabilization with external fixators- 2 cases. The final fixation was used after an adequate soft tissue condition was obtained, in a period of 8 to 25 days with an average of 14,3 days. Results: In 9 of 10 patients after surgical debridement was primar wound healing . In 1 patient with type IIIA fracture, which was not performed primar external fixation after final fixation complicated by osteitis of the femur. After 2 debridements formed a fistula, which was eradicated at 4 months, with internal metal fixator removal and bone defect plasty with composite based on collagen and antibiotic when the fracture was in the stage of consolidation. The functional score (Neer) in medium at all group of patients is 74 points. Conclusions: The surgical treatment of severe open fractures in 2 stages, with primar surgical debridement with stabilization by external fixators at first and functional stable internal fixation at second is a tactics to obtain optimal functional results and avoid complications.