Radiologically visible surgical error and poor outcome of internal fixation in distal femoral fractures.
BACKGROUND
Distal femoral fractures are usually complex and difficult to treat. The surgeon must demonstrate sound judgment in interpreting the fracture pattern and must possess a basic understanding of the principles of operative fracture management as well as knowledge of the mechanics of the implants.


METHODS
1 70 patients with distal femoral fractures were operated by 10 different orthopaedic surgeons from January 2003 to August 2006 using retrograde intramedullary nail and dynamic condylar screw within first two weeks after trauma. All patients who were labeled as failure as per the Criteria from Schatzker and Lambert 1979) were included in the study.


RESULTS
38 (22%) patients with distal femoral fractures were graded as poor results. Eleven (29%) fractures were fixed by using retrograde intramedullar nail and 27(71%) were treated by dynamic condylar screw. 25 (66%) poor results [6(16 %) in retrograde intramedullary nail group and 25(50 %) in dynamic condylar screw group ] were in the absolute control of the operating surgeon and 13(34%) poor results were not in the control of the operating urgeon.


CONCLUSIONS
Before undertaking the operative treatment of distal femoral fractures by using any of the advised methods, the surgeon must demonstrate sound judgment in interpreting the fracture pattern. In the present world of advanced technology the basic principles of fixation of fracture cannot be ignored as an important part of all orthopaedic surgeon's armantarium.
Nabi
Dar Gh
DG
Department of Orthopedics, Government Medical College, Srinagar, University of Kashmir. drgndar@yahoo.co.in
Rashid
Tak Shafaat
TS
Ahmed
Kangoo Khursheed
KK
Ahmed
Halwai Manzoor
HM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws / Q000009:adverse effects*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D007194:India; D016268:Internal Fixators / Q000009:adverse effects*; D008297:Male; D019300:Medical Errors; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome