EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Youssef et al
DISTAL FEMUR FRACTURES TREATED WITH PLATE FIXATION:
TO LOCK OR NOT TO LOCK
By
Ahmed Omar Youssef*, Nagy A. Sabet**, Ahmed Saleh Abd El-Fattah*,
Mohamed Mohamed E-Shafie*
Department of Orthopedic Surgery and Traumatology
*Minia Faculty of Medicine
**Misr University for Science and Technology
ABSTRACT:
Introduction: The objective of this study was to compare postoperative results and
functional outcomes of distal femur fractures treated with non-locking and locking
condylar plate fixation.
Materials and methods: Thirty-seven patients with distal femur were treated from
January 2005 to June 2008 and 34 of them met the inclusion criteria of this study.
They were randomly divided into two groups, based on the method of treatment.
Group I comprised 20 patients (14 men, 6 women) who had 20 distal femoral
fractures managed by condylar buttress plate. Group II consisted of 14 patients (10
men, 4 women) who had 14 distal femoral fractures managed by LCP condylar plate.
Results: The average duration of follow-up was 15 months (range 6–36 months).
Both groups were similar in mean age, gender distribution, mechanisms of injury,
fracture type and open fracture grade. The mean HSS score was 75.8 (range 53–90) in
group I and 77.1 (range 60–95) in group II. There was no significant difference with
regard to HSS scores between two groups (p=0.7055). According to the criteria set by
Schatzker and Lambert, excellent results were recorded in 5, good in 11, moderate in
1, poor in 3 patients with group I and excellent in 4, good in 9 and poor in 1 patient
with group II. The complications that occurred in the group I were one stiffness of the
knee (mean flexion 55°), two varus deformity 20°, one non-union with plate failure,
three delayed-union, and in the group II one stiffness of the knee (mean flexion 60°)
due to severe osteoarthritis and one delayed-union.
Conclusion: Comparison of non-locking versus locking condylar plates showed that
locking plates: required fewer bone grafts; had less surgical complications; had
similar percentages of immediate postoperative malaligned cases; were more stable
for long-term alignment; and had better clinical and functional outcomes. Considering
this, in our practice the locking plate have become the preferred option especially in
severe type 33-C2, 3 distal femur fractures.
KEYWORDS:
Distal femur fracture
Locked and non-locked condylar plate.
open fracture and poor bone quality
may decrease the stability of fixation.1
INTRODUCTION:
The treatment of comminuted,
intra-articular distal femoral fractures
is challenging. Many of these injuries
are the result of high-energy trauma,
which generates severe soft-tissue
damage and articular and metaphyseal
comminution. Bone loss resulting from
Traditional devices for internal
fixation have included the 95° condylar
blade-plate, the dynamic condylar
screw with a 95° side-plate, and
intramedullary nails. However, coronal
359
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
fractures
or
extensive
distal
comminution may preclude the use of
these devices. In such cases, a lateral
buttress or neutralization plate may be
used.2
Youssef et al
assistance before injury. Exclusion
criteria for this study were: (1) old
fractures (definitive surgery more than
3 weeks after the injury) and
pathological
fractures
except
osteoporosis; (2) severe open fractures
(Gustilo IIIB and IIIC). Thirty-four
patients who met these criteria were
randomly divided into two groups,
based on the method of treatment.
The condylar buttress plate was
the first implant designed to serve this
function. Unfortunately, when this
device is applied in the presence of
medial comminution or bone loss,
failure of fixation and varus collapse
may eventually result.3, 4
Group I comprised 20 patients (14
men, 6 women) who had 20 distal
femoral fractures managed by condylar
buttress plate. The types of fracture
were four A1, three A2, two A3, four
C1, three C2, and four C3 according to
the AO/OTA classification (Fig. 1).
The average time from the accident to
operation was 7 days (range 0–12
days). The causative factors were highspeed motor-vehicle accidents in 11
cases, fall from a height in 3 cases and
simple fall on flexed knee in 6 cases.
Of the 20 fractures, 2 were open; and
one of them was grade I and the other
one was grade II.
Recent advances in technology
for the treatment of distal femoral
fractures
include
the
Locking
Compression Plate (LCP) condylar
plate (Synthes). This implant offer
multiple points of fixed-angle contact
between the plate and screws in the
distal part of the femur, theoretically
reducing the tendency for varus
collapse that is seen with traditional
lateral plates. Early clinical studies of
the (LCP) have demonstrated a high
frequency of fracture union with low
rates of malalignment. 5-8
Group II consisted of 14 patients (10
men, 4 women) who had 14 distal
femoral fractures managed by LCP
condylar plate. The types of fracture
were two A1, one A2, two A3, two C1,
three C2, and four C3 according to the
AO/OTA classification. The average
time from the accident to operation
was 8 days (range 0–15 days). The
causative factors were high-speed
motor-vehicle accidents in 8 cases, fall
from a height in 3 cases and simple
fall on flexed knee in 3 cases. Of the
14 fractures, 1 was open grade IIIA.
This study was undertaken to
compare postoperative results and
functional outcomes of distal femur
fractures treated with non-locking and
locking condylar plate fixation.
PATIENTS AND METHODS:
From January 2005 to June
2008, 37 consecutive patients with
distal femur fractures were operatively
treated in our hospital. Inclusion
criteria for this study were: (1) acute
and unilateral fractures; (2) patients
with the ability to walk without any
360
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Youssef et al
Fig. 1: AO/OTA Classification of fractures of distal femur described by Müller et al, 1991. 9
inserted. At least four screws were
utilized for each main fragment.
Primarily iliac bone grafting was
performed in 3 cases with type C
fractures in group one. Limb length,
rotation, and axes were determined
using clinical and fluoroscopic
techniques. Then suction drains were
placed before wound closure.
Surgical technique:
Surgery was performed with
the patients in supine position on a
standard operating table that allowed
imaging of the knee with a C armed
image intensifier. Knee flexion was
achieved by placing a sterile towel
pillow under the knee. Tourniquet was
used in most of cases. The anterolateral
approach was performed with lateral
parapatellar extension for type C
fractures. Then the femoral condyles
were reduced and temporarily fixed
with K wires. A proper length condylar
plate (either non locked or locked) was
All patients were routinely
given a first-generation cephalosporin
(cefazolin)
and
aminoglycosides
(gentamicin) for 48 h starting just
before the induction of anesthesia.
361
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Continuous passive motion
(CPM) and physiotherapy with
active/passive motion were started
soon after removing the suction drains
on the second postoperative day. All
patients were followed at 6-week
intervals during the first 6 months
postoperatively and then at 3-month
intervals until final recovery.
Youssef et al
used to grade and compare the results
between the two groups (Table 1).
Knee
function
evaluation
was
performed according to Hospital for
Special Surgery Knee score (HSS
score).11
All data analysis was conducted on a
personal computer using the SPSS
software package (SPSS Inc., Chicago,
Illinois). A chi-square test was used for
categorical variables between the two
groups, such as sex, etc. A Student t
test was used for continuous variables,
such as age and range of motion. A
value of P < 0.05 was considered to be
statistically significant.
During the follow-up period,
fracture healing time and postoperative complications were recorded.
Plain films during the immediate postoperative and subsequent follow-up
period were reviewed for all patients.
Schatzker and Lambert criteria10 were
Table 1: Schatzker and Lambert criteria for functional assessment.10
Excellent—full extension:
 Flexion loss less than 10º.
 No varus, valgus or rotatory deformity.
 No pain.
 Perfect joint congruency
Good—not more than one of the following:
 Loss of length not more than 1.2 cm.
 Less than 10º varus or valgus.
 Flexion loss not more than 20º.
 Minimal pain.
Moderate—any two of the criteria in Good category.
Poor—any of the following:
 Flexion to 90º or less.
 Varus or valgus deformity exceeding 15º.
 Joint incongruency.
 Disabling pain no matter how perfect the X-ray.
group with an average duration of
follow-up of 18 months.
RESULTS:
The average duration of followup was 15 months (range 6–36
months). The patients treated with
locking plates had a shorter duration of
follow-up, with an average of
9 months, compared to the non-locking
Injury characteristics
Both groups were similar in
mean age, gender distribution,
mechanisms of injury, fracture type
and open fracture grade (Table 2).
362
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Youssef et al
Table 2: Demographic data and injury characteristics of the patients.
Mean age (years)
Group I
(n=20)
44.2
(range 21-65)
Gender
Male
Female
Mechanism of injury
High speed motor-vehicle accident
fall from a height
Fall on flexed knee
AO/OTA classification
Type A (No)
A1
A2
A3
Type C (No)
C1
C2
C3
Open fracture grade (No)
Gustilo type I
Gustilo type II
Gustilo type IIIA
Group I: condylar buttress plate group.
Group II: LCP condylar buttress plate group.
No: number of patients.
a
Student's t-test.
b
Chi-squared test.
Group II
(n=14)
45.9
(range 23-82)
P-value
0.7766 a
1.0000b
14
6
10
4
1.0000b
11
3
6
8
3
3
0.7282 b
9
4
3
2
11
4
3
4
2
1
1
0
5
2
1
2
9
2
3
4
1
0
0
1
1.0000b
immediate internal fixation within 6
hours from injury.
Surgical management
Twenty-six cases (76.5%) were
operated on within the first 5 days after
the fracture was sustained. Two open
cases had surgery delayed due to
temporary external fixation (for 12 and
15 days) prior to internal fixation. The
delay in surgery of more than 5 days
for the remaining six cases was due to
associated co-morbidities and other
injuries.
Primary iliac bone graft were
needed in 3 cases in group I with
severe comminuted osteoporotic fractures (type C2 and C3), which was not
needed in group II.
Operative time (skin incision to
closure) ranged between 90 minutes
and 160 minutes with no significant
difference between the two groups
(p=0.3577). Least operative time was
in simple non-comminuted fractures
and longest operative time was in
highly comminuted fractures; needing
Two out of three cases of open
fractures (grade II and IIIA) were
managed by temporary external
fixation prior to internal fixation. The
third case (grade I) managed by
363
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
larger exposure technique, more time
for reduction and alignment of
comminuted fragments. Also, there
were no significant difference between
Youssef et al
the two groups as regard peri-operative
blood loss and hospital stay (P
. (Table 3)
Table 3: Surgical details.
Group I
(mean±SD)
Surgical time (min)
119.0 ± 22.7
Peri-operative blood loss (mL)
370.0 ± 96.5
(range 200-500)
Primary bone graft (No)
3
Immediate postoperative
1
malalignment (No)
(varus 5°)
Hospital stay (days)
10.8 ± 9.9
(range 5-35)
Group I: condylar buttress plate group.
Group II: LCP condylar buttress plate group.
No: number of patients.
* Statistical significance was detected.
a
Student's t-test.
b
Chi-squared test.
Group II
(mean±SD)
126.4 ± 23.1
400.0 ± 103.8
(range 200-550)
0
1
(varus 5°)
11.4 ± 9.1
(range 5-28)
P-value
0.3577a
0.3935 a
0.2513 b
1.0000b
0.8514 a
The mean HSS score was 75.8
(range 53–90) in group I and 77.1
(range 60–95) in group II. There was
no significant difference with regard to
HSS scores between two groups (p=
0.7055). The mean range of knee
motion was 105.5 (range 5–125) in
group I and 112.5 (range 60–125) in
group II. There was no significant
difference with regard to range of knee
motion between two groups (p=
0.3270).
Radiographic assessment
Assessment of the fracture in
terms of valgus/varus alignment on
postoperative radiographs showed
correct axial alignment (<5° deviation
compared to the anatomical axis in
both planes) in 32 patients. Only 2
patients had 5° varus alignment, one in
each group. Follow-up x-ray showed
20° varus collapse in two patients in
group I. (Table 3, 4)
Clinical evaluation
Based on the criteria proposed
by Schatzker and Lambert, the
outcomes were assessed as excellent in
5 cases, good in 11, moderate in 1, and
poor in 3 in group I and as excellent in
4, good in 9, and poor in 1 in group II.
The poor results of group I were
because of 20° varus deformity in 2
cases and stiff painful knee due to deep
infection in one case.
Complications
Three cases in the non-locking
plate group developed superficial
infection treated with oral antibiotics.
Also, one case develop deep infection
treated by debridement end in painful
stiff knee. This complication was not
recorded in the locking plate group.
Twenty degrees varus collapse
develop in 2 cases in group I detected
364
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
in follow-up x-ray done after 6 weeks.
Secondary iliac bone graft for delayedunion was needed in 3 cases in group I
and one case in group II. Non-union
and plate failure occurred in one case
Youssef et al
in group I managed by revision with
locked plate and bone graft.
Three patients had subsequent removal
of hardware (all non-locking plates)
due to pain.
Table 4: Post-operative outcomes and complications.
Radiographic healing time (weeks)
Union rate (%)
Total arc of knee motion (degrees)
Mean HSS knee score (points)
Group I
(n=20)
18.0 ± 9.95
(range 12-48)
95
105.5 ± 22.7
(range 55-125)
75.8±10.8
(range 53-90)
Functional outcome according to
Schatzker and Lambert:
5
 Excellent
11
 Good
1
 Moderate
3
 Poor
Complications (No)
Infection
3
 Superficial infection
1
 Deep infection
2
Varus collapse (20°)
3
Delayed union (need secondary
bone graft)
1
Plate failure and nonunion (revision
and bone graft was done)
3
Painful plate
Group I: condylar buttress plate group.
Group II: LCP condylar buttress plate group.
No: number of patients.
* Statistical significance was detected.
a Student's t-test.
b Chi-squared test.
365
Group II
(n=14)
16.9 ± 6.5
(range 12-38)
100
112.5 ± 15.8
(range 60-125)
77.1±9.9
(range 60-95)
P-value
0.7087
a
1.0000 b
0.3270a
0.7055a
0.3786 b
4
9
0
1
0
0
0
1
0
0
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Youssef et al
Figs. 2-A and 2-B: A sixty-year-old man was involved in a high-speed motor-vehicle
accident. Fig. 2-A: Anteroposterior and lateral radiograph on the left knee showing
fracture distal femur AO/OTA classification type 33-C3. Fig. 2-B: Follow-up
anteroposterior and lateral radiograph after fixation by condylar buttress plate, made
at six months, demonstrating fracture-healing without loss of reduction and without
varus collapse.
Figs. 3-A and 3-B: A twenty-two-year-old man was injured due to fall from a height.
Fig. 3-A: Anteroposterior and lateral radiograph on the left knee showing fracture
distal femur AO/OTA classification type 33-C1.
Fig. 3-B: Follow-up anteroposterior and lateral radiograph after fixation by condylar
buttress plate, made at twelve months, demonstrating fracture-healing without loss of
reduction and without varus collapse.
366
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Youssef et al
Figs. 4-A and 4-B: A fifty-five-year-old woman was involved in a high-speed motorvehicle accident. Fig. 4-A: Anteroposterior and lateral radiograph on the right knee
showing fracture distal femur AO/OTA classification type 33-C2. Fig. 4-B: Followup anteroposterior radiograph after fixation by condylar buttress plate, made at three
months, demonstrating 20° varus collapse.
Fig. 5: A sixty-five-year-old woman was involved in a high-speed motor-vehicle
accident. Follow-up anteroposterior and lateral radiograph on the right knee showing
fracture distal femur AO/OTA classification type 33-C3 associated with fracture
patella. The condylar buttress plate was broken and revision surgery was needed.
Figs. 6-A through 6-C: A sixty-five-year-old woman was involved in a high-speed
motor-vehicle accident. Fig. 6-A: Anteroposterior and lateral radiograph on the right
knee showing fracture distal femur AO/OTA classification type 33-C3.
367
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Youssef et al
Fig. 6-B: Follow-up anteroposterior and lateral radiograph after fixation by LCP
condylar buttress plate, made at twelve months, demonstrating fracture-healing
without loss of reduction and without varus collapse.
Fig. 6-C: Follow-up photograph of the patient showing good range of knee flexion
and extension.
Figs. 7-A and 7-B: A seventy-year-old man was injured due to fall on flexed knee.
Fig. 7-A: Anteroposterior and lateral radiograph on the left knee showing fracture
distal femur AO/OTA classification type 33-A1. Fig. 7-B: Follow-up anteroposterior
and lateral radiograph after fixation by LCP condylar buttress plate, made at twelve
months, demonstrating fracture-healing without loss of reduction and without varus
collapse. But the patient had severe osteoarthritis associated with pain and stiffness.
368
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
Youssef et al
advantage of locked plating systems.
In fact, the “hybrid” plating technique,
as initially described by Ricci et al.17
and later studied by Freeman et al. 18
utilizes nonlocked screws to compress
the plate against the bone. The plate
contour is used as a reduction aid and
then locked screws are used to obtain
improved biomechanics. This locked/
nonlocked screw combination is now
becoming standard technique.
DISCUSSION:
Internal fixation options for
fractures of the distal femur, usually
caused by high-energy trauma, are a
95° blade plate, dynamic condylar
screw (DCS), and condylar buttress
plate. With these techniques, higher
complications rates due to postoperative infection and nonunion are
not uncommon during the treatment
because of additional soft tissue and
blood supply damage especially in
comminuted fractures.2, 12
Although locked plating technology is not always necessary, it is
often indicated for complex metaphyseal fractures of the distal femur,
proximal tibia, distal tibia, or supracondylar region of the distal humerus
and radius. These fractures are often
comminuted and commonly occur in
elderly patients with osteoporotic bone.
As of yet few prospective studies exist
that definitively demonstrate superiority of locked plating in difficult
metaphyseal or osteoporotic fractures.
Nonlocked plates, dependent on
friction for stability, must be coupled
with adequate screw purchase. Osteoporotic bone often cannot achieve the
torque necessary to maintain such
construct stability, making locked
plating applications in osteoporotic
bone particularly advantageous. 19
The development of fixed-angle
locking plates has altered the mainstay
of internal plate fixation; however
there is minimal data on longer-term
follow-up of patients treated with
locking plates, particularly with
respect to functional outcomes13, 14.
Expectations
for
superior
performance for locked plating
fixation, based on preliminary biomechanical data, rests on 3 observations:
(1) a single beam construct design is
better maintained for locked plating
and is less dependent on bone quality
than for nonlocked plating therefore
providing superior stability, (2) the
design of locked constructs permits a
reduced need for bone/plate friction,
which minimizes biologic insult, and
(3) the locked plate construct resists
varus/valgus collapse of end segment
fractures. 15
Seven out of the 20 cases treated with non-locking condylar buttress
plate had bone grafting compared with
only 1 out of 14 cases treated with
LCP condylar buttress plate, and 10
cases in the non-locking plate group
had direct complications related to the
surgery, compared with one in the
locking plate group. Three of the nonlocking plate group had subsequent
removal of hardware due to pain,
compared with none in the locking
plate group.
The development of locked
plating was fueled by the failure of
traditional compression methods to
provide fracture stability while still
preserving blood supply to bone. Early
fixed-angle plate systems evolved out
of the goal to reduce plate contact with
the periosteum.16
However, it is now evident that
the biologic advantage of reduced
contact of plate to bone is only one
The smaller groups number
makes it difficult to draw statistically
369
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
significant conclusions from these
results and a larger study would be
required to adequately compare the
need for bone grafting and the risk of
surgical complications.
Youssef et al
fracture of the femur. J Bone Joint
Surg Am. 1989, 71: 95-104.
3. Bolhofner BR, Carmen B,
Clifford P. The results of open
reduction and internal fixation of distal
femur fractures using a biologic
(indirect) reduction technique. J
Orthop Trauma. 1996; 10: 372-7.
4. Mast J, Jakob R, Ganz R.
Planning and reduction technique in
fracture surgery. New York: Springer;
1989.
5. Egol
KA,
Kubiak
EN,
Fulkerson E, Kummer FJ, Koval KJ.
Biomechanics of locked plates and
screws. J Orthop Trauma. 2004; 18:
488-93.
6. Frigg R. Development of the
locking compression plate. Injury.
2003; 34 Suppl 2: SB6-10.
7. Sommer C, Gautier E, Muller
M, Helfet DL, Wagner M. First clinical
results of the Locking Compression
Plate (LCP). Injury. 2003; 34 Suppl 2:
B43-54.
8. Stoffel
K,
Dieter
U,
Stachowiak G, Gachter A, Kuster MS.
Biomechanical testing of the LCP—
how can stability in locked internal
fixators be controlled? Injury. 2003; 34
Suppl 2: SB11-9.
9. Muller ME, Allgower M,
Schneider R. Manual of internal
fixation: techniques recommended by
the AO/ASIF Group, 3rd edn.
Springer, Berlin Heidelberg New
York, 1991.
10. Schatzker J, Lambert DC.
Supracondylar fractures of the femur.
Clin Orthop. 1979; 138: 77–83.
11. Insall JN, Ranawat CS, Aglietti
P, Shine J.A comparison of four
models of total knee-replacement
prostheses. J Bone Joint Surg Am
1976; 58(6): 754-65.
The percentages of immediate
postoperative malaligned cases were
similar between the non-locking and
locking plate groups (one case in each
group). In the non-locking plate group
the degree of malalignment generally
worsened
with
serial
imaging,
indicating progressive bony collapse
and failure to maintain reduction.
Since progressive loss of reduction was
only identified in the non-locking plate
group, it is clear that locking plates
provide more stable long-term fixation.
CONCLUSION:
Comparison of non-locking
versus locking condylar plates shows
that locking plates: required fewer
bone grafts; had less surgical
complications; had similar percentages
of immediate postoperative malaligned
cases; were more stable for long-term
alignment; and had better clinical and
functional outcomes. Considering this,
in our practice the locking plate have
become the preferred option especially
in severe type 33-C2, 3 distal femur
fractures. Obviously, a larger study
with age-matched, fracture classifycation-matched and health statusmatched groups might identify
statistically significant superior functional outcomes in the locking plate
group.
REFERENCES:
1. Zlowodzki M, Bhandari M,
Marek DJ. Operative treatment of
acute distal femur fractures: systematic
review of 2 comparative studies and 45
case series (1989 to 2005). J Orthop
Trauma. 2006; 20: 366-371.
2. Siliski JM, Mahring M, Hofer
HP:
Supracondylar-intercondylar
12. Huang HT, Huang PY, Su JY,
Lin SY. Indirect reduction and bridge
plating of supracondylar fractures of
the femur. Injury 2003; 34: 135–40.
370
EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009
13. Wang
JW,
Weng
LH.
Treatment of distal femoral nonunion
with internal fi xation, cortical
allograft struts, and autogenous
bonegrafting. J Bone Joint Surg Am
2003; 85: 436–40.
14. Chapman MW, Finkemeier
CG. Treatment of supracondylar
nonunions of the femur with plate fi
xation and bone graft. J Bone Joint
Surg Am 1999; 81: 1217–28.
15. Soileau R, Cartner J, Zheng Y.
Locked Versus Conventional PlateScrew Fixation in Osteoporotic Bone:
A Review. Techniques in Orthopaedics
2007; 22(4): 247–252.
16. Farouk O, Krettek C, Miclau T,
et al. Minimally invasive plate
osteosynthesis: does percutaneous
plating disrupt femoral blood supply
less than the traditional technique? J
Orthop Trauma 1999; 13: 401– 406.
Youssef et al
17. Ricci WM, Loftus T, Cox C, et
al. Locked plates combined with
minimally invasive insertion technique
for the treatment of periprosthetic
supracondylar femur fractures above a
total knee arthroplasty. J Orthop
Trauma 2006; 20: 190 –196.
18. Freeman AL, Tornetta P,
Schmidt A, et al. How much does the
addition of locked screws add to the
stability of hybrid plate constructs in
osteoporotic bone? J Orthop Trauma
2007.
19. Leung F, Chow S. A
prospective,
randomized
trial
comparing the limited contact dynamic
compression plate with the point
contact fixator for forearm fractures. J
Bone Joint Surg Am 2003; 85: 2343–
2348.
371
‫‪Youssef et al‬‬
‫‪EL-MINIA MED. BULL. VOL. 20, NO. 1, JAN., 2009‬‬
‫التثبيت بواسطة الشرائح لكسور أسفل عظمة الفخذ‪:‬‬
‫استخدام الغلق أو عدم أستخدامة‬
‫تهدف هذه الدراسة مقارنة نتائج كسور أسفل الفخذذ ااسذتخداا اليذر اة الدا مذة ليقمتذ‬
‫والير اة ذات ة الغيذ‪ .‬يذميا الدراسذة سذاثة ون نذ مر عذا و ثذانو مذ كسذور أسذفل مذة‬
‫الفخذذ يذذل الفتذر مذ نذا ر ‪2005‬ا إلذذي ون ذذو ‪ 2008‬ا انطاقذا يذذروط الدراسذة يذذي أراثذذة‬
‫ون ن منها وقد تا تقس مها إلي مجمو ت ااسب طر قة الث ج المجمو ة األولل تتكو م‬
‫ير مر عا و (‪ 14‬ذكر و ‪ 6‬إناث) وتا جها اواسطة الير اة الدا مة ليقمت والمجمو ة‬
‫النان ة تتكو م أراثذة يذر مر عذا و (‪ 10‬ذكذور و ‪ 4‬إنذاث) قذد كذا متوسذط الثمذر والجذن‬
‫وآل ذذة اذذدوث اة ذذااة ونو ذذة الكسذذر واالتذذ م ذ ا ذذث كسذذر مفتذذوي أو مغيذذ‪ .‬متقاراذذا و يذذل‬
‫المجمو ت كا متوسط مد المتااثة خمسة ير يهرا و ( م ‪ 36 – 6‬يهر ) وتا تق ا النتائج‬
‫اطر قة ياتذكر ولمارا وكانا النتائج ممتاز يذل خمذ اذاوا وج ذد يذل أاذد يذر االذة‬
‫ومتوسطة يل االة وااد وس ئة يل ن ث ااوا يل المجمو ة األولل وكانا ممتاز يل أراثة‬
‫ااوا وج د يل تسثة ااوا وس ئة يل االة وااد يل المجمو ذة النان ذة وكانذا معذا فاا‬
‫المجمو ة األولل ت ا االركاة يل االة وااد واالت تقو االساق ليذداخل ‪ 20‬درجذة واالذة‬
‫دا التئاا اساب ييذل اليذر اة ون نذة اذاوا تذيخر يذل اولتئذاال ويذل المجمو ذة النان ذة االذة‬
‫وااد ت ا االركاة نت جة خيونة يد د امف ل الركاة واالة تيخر التئاا‬
‫الخالصة ‪:‬‬
‫أ المقارنة ا الير اة الدا مة ليقمت ذات ة الغي‪ .‬وغ ر ذات ة الغي‪ .‬ل ا نا أ اليرائح ذات ذة‬
‫الغي‪ .‬نادرا و ما تاتاج إلي رقثة م ة وأقذل مذ ا ذث المعذا فاا الجراا ذة وكانذا اليذر اة‬
‫ذات ة الغي‪ .‬أكنر نااتا و وأقل ادونا و لتقو الركاة يذي المذد الطو ذل وايخذذ ذلذي يذل او تاذار‬
‫يإ الير اة ذات ذة الغيذ‪ .‬أ ذااا هذل اوخت ذار األيعذل يذل ذ ج كسذور أسذفل مذة الفخذذ‬
‫وخا ة تيي الكسور المتداخية مع مف ل الركاة‬
‫‪372‬‬