Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 7 Issue 3

Management of Complex Open Distal Femur Fractures with Fibula and Cancellous Graft: Case Series

Keyur Patel*

Orthopaedic Surgeon, Gujarat, India

*Corresponding Author: Keyur Patel, Orthopaedic Surgeon, Gujarat, India.

Received: January 22, 2024; Published: February 26, 2024


Purpose: To report functional and radiological outcomes of using lateral plate and debridement in stage 1 followed by fibular strut graft together with cancellous graft and medial plating in second stage after 3-4 weeks in distal femoral fractures. In 5 cases, 3 were operated in staged manner and 2 cases with single stage bone grafting and platting amongst which one case (33-A3) with vascular injury operated with single lateral plate and fibula and cancellous graft in second stage.

Method: A retrospective study on 5 patients with comminuted distal femoral open grade fractures managed single/dual stage single/dual plate and fibula and cancellous grafting by Swashbuckler approach has been conducted. Only distal femoral fractures type 33-A3, 33-C2, and 33-C3, were included. The patient’s mean age was 25.2 years. Evaluation included operative time, blood loss, time to union, knee range of motion, Sanders scoring, and presence of complications.

Results: All patients had no postoperative knee stiffness with a range of motion (90-120°) during follow-up. The time for radiological union was at 3 months, with no cases of non-union. The average follow-up period was 3 to 4 months and 6month and yearly follow up are yet to come. Mean intraoperative blood loss was 325 ml, and mean operative time was 76.87 min without anaesthesia. All patients had a knee range of motion (90–120°) during follow-up. Time for union at 3 months, with no cases of non-union. A total of 5 patients 3 (60%) showed excellent functional outcomes, and the remaining 2 (40%) showed good functional outcomes according to the Sanders scoring system. Only one cases had late infections (1yr post op) managed by implant removal after 1 year. No post-operative deformity, loss of reduction, or implant failure was observed until the end of follow-up period

Conclusion: Staged debridement with single plate f/b 2nd fibular grafting and medial plate in more contaminated and single staged procedure in non-contaminated cases BG and dual plating of comminuted distal femur fractures in patients is an effective technique with higher rates of union and lower re-operation rates compared to other fixation modalities.

Keywords: Open Distal Femur Fractures; Fibula; Cancellous Graft


  1. Schemitsch EH. “Size matters: defining critical in bone defect size”. Journal of Orthopaedic Trauma 10 (2017): S20-S22.
  2. Roddy E., et al. “Treatment of critical-sized bone defects: clinical and tissue engineering perspectives”. European Journal of Orthopaedic Surgery and Traumatology 3 (2018): 351-362.
  3. Sanders R., et al. “Double-plating of comminuted, unstable fractures of the distal part of the femur”. The Journal of Bone and Joint Surgery. American Volume 3 (1991): 341-346.
  4. Harahap R. “Surgical incision technique approach on distal femur fracture a literature review”. Al-Iqra Medical Journal: Jurnal Berkala Ilmiah Kedokteran1 (2021): 31-39.
  5. Starr AJ., et al. “The “swashbuckler”: a modified anterior approach for fractures of the distal femur”. Journal of Orthopaedic Trauma 2 (1999): 138-140.
  6. Ahire DR., et al. “A comparative study between swashbuckler approach (Modified Anterior Approach) and lateral approach for the distal femur fractures”. International Journal of Orthopaedics Sciences 3 (2018):184-188.
  7. Ricci WM., et al. “Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases”. Journal of Orthopaedic Trauma 2 (2014): 83-89.
  8. Moloney GB., et al. “Geriatric distal femur fracture: are we underestimating the rate of local and systemic complications?” Injury 47 (2016): 1732-1736.
  9. Peschiera V., et al. “Predicting the failure in distal femur fractures”. Injury3 (2018): S2-S7.
  10. Ziran BH., et al. “Lateral and anterior plating of intra-articular distal femoral fractures treated via an anterior approach”. International Orthopaedics 6 (2002): 370-373.
  11. Steinberg EL., et al. “A double-plating approach to distal femur fracture: a clinical study”. Injury 10 (2017): 2260-2265.
  12. Tripathy SK., et al. “Dual-plating in distal femur fracture: a systematic review and limited meta-analysis”. Indian Journal of Orthopaedics 56 (2022): 183-207.
  13. Todorov D., et al. “Is augmented LISS plating biomechanically advantageous over conventional LISS plating in unstable osteoporotic distal femoral fractures?” Journal of Orthopaedic Research 10 (2018): 2604-2611.
  14. Prayson MJ., et al. “Mechanical comparison of endosteal substitution and lateral plate fixation in supracondylar fractures of the femur”. Journal of Orthopaedic Trauma 2 (2001): 96-100.
  15. Hak DJ., et al. “The influence of fracture fixation biomechanics on fracture healing”. Orthopedics 33 (2010): 752-755.
  16. Lujan TJ., et al. “Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation”. Journal of Orthopaedic Trauma 24 (2010): 156-162.
  17. Zlowodzki M., et al. “Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005)”. Journal of Orthopaedic Trauma 20 (2006): 366-371.


Citation: Keyur Patel. “Management of Complex Open Distal Femur Fractures with Fibula and Cancellous Graft: Case Series".Acta Scientific Orthopaedics 7.3 (2024): 88-93.


Copyright: © 2024 Keyur Patel. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is April 30th, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue".
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US