[Results of surgical management of distal femur fractures with joint involvement].

Results of the treatment of 60 intraarticular distal fractures of the femur (AO classification: 33-B and 33-C fractures) are summarized. Frequencies of the different types of fractures were B1, 7; B2, 10; B3, 4; C1, 10; C2, 1; C3, 8. In 36 patients an isolated fracture, was present, in 9 patients, one additional injury, and in 16 patients there was more than one fracture or multiple trauma. We found 16.7% open fractures. Operation was possible within 24 h in 16 patients, in 21 patients between the 2nd and the 5th days, and in the rest after the 5th day. Check-ups took place an average of 46.4 months after the accident. The average age of the patients was 64.1 years (16-93). We encountered 3 cases of infection; we were able to treat 2 of these successfully, while 1 led to chronic osteomyelitis. Further complications were: loosening of implants (6 cases), non-union (1) fractures of plates (2), haematoma requiring operative treatment (1) refracture (1). All fractures resulted in osseous consolidation. Mobilization of patients was achieved an average of 12 days after operation. We evaluated the cases according to the Neer score. In 32 cases the result was excellent, in 18, average and in 4, unsatisfactory. Failure had to be recorded in 1 case. The combination of locking nails and lagscrews is an alternative method of osteosynthesis for distal femural fractures with an intra-articular component, provided strict selection criteria are applied.