Management of complex distal femur fractures with bone loss using the ‘three-in-one technique’
Khaled, A., El-Rosasy, M., Shafik, A., El-Gebaly, O. (2023). Management of complex distal femur fractures with bone loss using the ‘three-in-one technique’. EKB Journal Management System, 58(3), 159-168. doi: 10.4103/eoj.eoj_90_23
Abdullah Khaled; Mahmoud El-Rosasy; Ahmed Shafik; Osama El-Gebaly. "Management of complex distal femur fractures with bone loss using the ‘three-in-one technique’". EKB Journal Management System, 58, 3, 2023, 159-168. doi: 10.4103/eoj.eoj_90_23
Khaled, A., El-Rosasy, M., Shafik, A., El-Gebaly, O. (2023). 'Management of complex distal femur fractures with bone loss using the ‘three-in-one technique’', EKB Journal Management System, 58(3), pp. 159-168. doi: 10.4103/eoj.eoj_90_23
Khaled, A., El-Rosasy, M., Shafik, A., El-Gebaly, O. Management of complex distal femur fractures with bone loss using the ‘three-in-one technique’. EKB Journal Management System, 2023; 58(3): 159-168. doi: 10.4103/eoj.eoj_90_23

Management of complex distal femur fractures with bone loss using the ‘three-in-one technique’

The Egyptian Orthopaedic Journal
Volume 58, Issue 3, November 2023, Pages 159-168    PDF (6.35 M)
DOI: 10.4103/eoj.eoj_90_23
Authors
Abdullah Khaled; Mahmoud El-Rosasy; Ahmed Shafik; Osama El-Gebaly
Abstract
Purpose
The reconstruction of complex distal femur fractures with bone loss is a surgical challenge. The aim of the present study was to evaluate the effectiveness of the ‘three-in-one’ surgical technique, which combines a retrograde nail linked to a lateral locked plate with defect reconstruction using a bone graft in a synthetic scaffold.
Materials and Methods
A prospective study was conducted at a level 1 trauma centre from 2016 to 2021. Comminuted distal femur fractures (OTA/AO type 33A3, 33C2, or 33C3) with bone loss in skeletally mature patients were included. The ‘three-in-one’ surgical technique was used in all cases.
Results
The present study comprised 14 cases with a mean age of 28 years (range, 18–58 years). The bone defect sizes ranged from 3 to 8 cm. Ten cases (71%) had open fractures. Operative duration ranged between 150 and 210 min (Average 175 min). Excellent, good and fair outcomes according to sanders score were achieved in eight (57%), five (36%) and one case (7%), respectively. There were no cases of implant failure or varus collapse. Postoperative follow-up ranged from 12 to 53 months (mean 27 months).
Conclusion
Management of complex distal femur fractures using the ‘three-in-one technique’ (retrograde nail fixation augmented by anatomical lateral locked plate and reconstruction of the bone defect using autologous bone grafts in a scaffold of synthetic oxidised cellulose gauze) for complex distal femur fractures provides a stable biomechanical construct that allows fracture healing and early rehabilitation in a single stage through a single approach.
Keywords
Bone loss; distal femur; Nail- plate construct; oxidised cellulose; synthetic scaffold
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