Early functional outcome of distal femoral fractures treated operativeley at Kenyatta National Hospital and P.C.E.A Kikuyu Mission Hospital

Abstract

Background: Distal femoral fractures account for 4% to 7% of all femoral fractures': 20,21. They cause considerable morbidity and mortality, especially in the elderly. Locally they occur mainly in the young socio-economically active age group; with the majority caused by automobile accidents 19. With increasing high energy lifestyles and increasing longevity, the incidence is projected to rise. Functional outcome of treatment of these injuries has however not been critically studied at KNH and PCEA Kikuyu Mission Hospital setup. Objective: To determine early functional outcome of operative treatment of distal femoral fractures at KNH and P.C.E.A. Kikuyu mission Hospital Design and setting: This was a prospective cohort study conducted at the orthopedics and trauma wards and fracture clinics at Kenyatta National Hospital and PCEA Kikuyu mission Hospital.

Patients and methods: 46 patients were recruited by consecutive sampling after they underwent open reduction and internal fixation. They were followed up for a period of three months during which any complications were noted. At three months they were assessed for knee range of motion, pain, knee ligament stability, ability to walk and climb stairs and muscle strength. Femor?-tibial alignment was determined from a review of the AP and lateral radiographs of the knee. The Hospital for specialized surgery knee score was then determined. Results: There were 18 females and 28 males all totalling to 46. Majority were in the age bracket 25.45 years (70.6%). The leading cause of injury was RTA, followed by falls from a height. Thirty (65%) patients were treated using DeS, 11 (23.9%) with retrograde intramedullary nailing and 5 (10.9) with 9S0-angle plate. 89% had good to excellent functional outcome 12 weeks after surgery. 1 patient suffered periprosthetic fracture and poor function at 3 months. There was 1patient who suffered superficial wound infection. 78% had knee range of motion above 90ﾰ and 8.8% had below 60ﾰ of motion. 1 patient had no radiological union at 12 weeks. Conclusions: ﾷ Male: female ratio was 1.6: 1. There was a slight male preponderance. ﾷ Young socio-economically active individuals formed the majority of those with these mjunes ﾷ High energy trauma was the leading cause: RTA. ﾷ Following operative fixation, functional outcome was predominantly good or excellent ﾷ Knee stiffness was the leading complication.