Early functional outcome of distal femoral fractures at Kenyatta National Hospital and Kikuyu Hospital
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Background: Distal femoral fractures account for 4% to 7% of all femoral fractures. 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. 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 Kenyatta National Hospital and PCEA Kikuyu Mission Hospital setup. Objective: To determine early functional outcome of operative treatment of distal femoral fractures. Design: Hospital based prospective study. Setting: Orthopaedics and trauma wards and fracture clinics at Kenyatta National Hospital and PCEA Kikuyu Mission Hospital. Patients and methods: Forty six 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. Femoro-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 was RTA, followed by falls from a height. Thirty (65%) patients were treated using DCS, 11 (23.9%) with retrograde intramedullary nailing and 5 (10.9%) with 950-angle plate. Eighty nine percent had good to excellent functional outcome 12 weeks after surgery. One patient suffered periprosthetic fracture and poor function at 3 months. There was one patient who suffered superficial wound infection. Seventy eight percent had knee range of motion above 900 and 8.8% had below 600 of motion. One patient had no radiological union at 12 weeks. Conclusions: Following operative fixation, functional outcome was predominantly good or excellent. Knee stiffness was the leading complication. Young socio-economically active individuals formed the majority of those with these injuries, with a male: female ratio of 1.6:1 Road Traffic Accidents (RTA) was the leading cause.