title: External fixation of distal femoral fractures in adults' multicentre retrospective study of 43 patients.
abstract: BACKGROUND
  A multicenter cohort of 43 adults with distal femoral fractures (DFFs) managed with external fixation was evaluated to determine the potential of this treatment.
  
  
  METHODS
  The patients were young adults (mean age: 39.6 years) with high-energy trauma; 12 had polytrauma and 41 multiple fractures. Most patients (38/43) had compound DFFs. Fracture types were A in 3 patients, B in 3 patients, and C in 37 patients. A tibio-femoral construct was required in 11 patients and a femoro-femoral construct in 32 patients.
  
  
  RESULTS
  The normal femoral axis was restored within 5° in the coronal plane in 34 (79%) patients and in the sagittal plane in 22 (51%) patients. Axis restoration within 5° in both planes was achieved in 19 (44.7%) patients. After femoro-femoral external fixation, mean malalignment was 4.2° in the coronal plane and 8.6° in the sagittal plane; corresponding values after tibio-femoral external fixation were 1.3° and 8.6°. In 23 patients (of whom 1 was lost to follow-up), external fixation was intended as the only and definitive treatment; among them, 1 required amputation after a failed revascularization procedure, 10 achieved fracture healing within a mean of 21.2 weeks, 6 required conversion to another technique, and 5 underwent non-conservative procedures (total knee arthroplasty in 3 and arthrodesis in 2). In the remaining 20 patients, conversion to internal fixation was intended initially and performed within a mean of 4.7 weeks; 1 of these patients required amputation for ischemia, 3 did not achieve fracture healing, 12 achieved primary fracture healing, and 4 achieved fracture healing after repeated grafting (n=3) or osteotomy (n=1). At last follow-up (at least 1 year), the mean International Knee Society (IKS) Function Score was 67.3 and an IKS Knee Score of 68.5. Range of active flexion was 85.75° overall, 62.3° in the group with intended definitive external fixation and 101° in the group with intended conversion to internal fixation. Healing without complications was achieved in 10 (43%) in the former group and 12 (60%) in the latter group.
  
  
  CONCLUSIONS
  Our data support provisional external fixation followed by early conversion to internal fixation in patients with extensively compounded DFFs; patients with multiple fractures requiring several surgical procedures; and polytrauma patients awaiting hemodynamic, respiratory, or neurological stabilization.
  
  
  METHODS
  IV, retrospective study.
authors.affiliation: Département de chirurgie orthopédique et traumatologique, institut de l'appareil locomoteur, hôpital Riquet, CHU de Toulouse, place du Dr Baylac, 31052 Toulouse-Purpan cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Bedes
authors.affiliation: Département de chirurgie orthopédique et traumatologique, institut de l'appareil locomoteur, hôpital Riquet, CHU de Toulouse, place du Dr Baylac, 31052 Toulouse-Purpan cedex, France. Electronic address: bonnevialle.p@chu-toulouse.fr.
authors.forename: P
authors.initials: P
authors.lastname: Bonnevialle
authors.affiliation: Service de chirurgie orthopédique et traumatologie, hôpital Hautepierre 1, université de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France.
authors.forename: M
authors.initials: M
authors.lastname: Ehlinger
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU Carémeau, place du Pr Debré, 30029 Nîmes cedex 9, France.
authors.forename: R
authors.initials: R
authors.lastname: Bertin
authors.affiliation: Service de chirurgie orthopédique et traumatologique, hôpital européen Georges-Pompidou, université René-Descartes, 20, rue Leblanc, 75015 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Vandenbusch
authors.affiliation: Service de chirurgie orthopédique et traumatologique, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
authors.forename: G
authors.initials: G
authors.lastname: Piétu
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003663:Decision Trees; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005592:Fracture Fixation / Q000379:methods*; D017102:Fracture Healing; D005597:Fractures, Open / Q000601:surgery; D005602:France; D006801:Humans; D008297:Male; D016059:Range of Motion, Articular; D012189:Retrospective Studies
keywords: Distal femoral fracture; External fixator; Open femoral fracture