Augmented Osteosynthesis in Fractures of the Distal End of the Femur in Elderly Patients: Surgical Technique, Anatomical and Functional Results

Abstract

Introduction: The term augmented osteosynthesis refers to the surgical management of a fracture by combining an osteosynthesis device with polymethyl methacrylate (PMMA), or by using two plates, or a nail and a plate to increase the stability of the construct. Objective: The specific objectives were to describe the clinical and functional outcomes of patients operated with a locked distal femoral plate augmented with a standard viscosity acrylic cement, the radiological results and the complications encountered. Patients and Method: This is a case series study with descriptive and analytical aims, conducted over a 5-year period from 1 January 2018 to April 2023. The AO/OTA classification was used for the radiological classification of fractures. Gait was assessed using the Parker score. Functional outcome of the knee was assessed using the MEGY functional score. Our study population consisted of 44 cases. The mean age of the patients was 80.66 years, with the (55-90) age group the most affected. Both sexes were represented, with female domination. Domestic accidents were responsible for 88.6% of fractures of the distal end of the femur in patients aged over 65. The left side was most affected in 72.7% of cases. Periprosthetic fractures accounted for 38.6% of fractures. A1 fractures were the most common (55%). The average waiting to operate time was 3 days. The Locked-compression distal, lateral femoral plate with polymethyl methacrylate ciment augmentation was used in all our patients. The mean operative time was two hours and 12 minutes. Results: Physiotherapy was started early in 86.4% of patients. The mean time to consolidation was 6 months. The consolidation rate was 95.4%. Residual knee pain was the most common late complication (34.1%), followed by pseudarthrosis (13.6%), infection, reduction failure and implant rupture. The overall functional result was satisfactory in 93.2% of cases, very good in 43.2% and good in 34.1%. Conclusion: Augmented osteosynthesis for distal femur fractures in elderly patients must combine stability, solidity, rapid act and immediate rehabilitation in order to achieve good consolidation and a good functional result and avoid early morbidities and mortalities.