Fracturas de la extremidad distal del fémur. Tratamiento quirúrgico versus tratamiento ortopédico

Summary.—The results obtained in 72 fractures of the distal femur in 70 patients were asses­ sed with regard to the treatment type, surgical or conservative. There were 23 women and 47 men, with a 50 year-old mean age. The most frequent type of fracture was the supracondylar non-com­ minuted (42%). In 40 cases (56%) concomitant lesions were registered, with a total of 48 associa­ te fractures. In two cases the fracture was bilateral. Twenty-four fractures were treated by ortho­ paedic means (traction-suspension system or plaster cast) and 48 by surgery. The surgical techni­ que consisted on open reduction and internal fixation in 47 cases (plate and screws 21 cases, 17 with the AO plate and 9 with the DCS plate). The results were evaluated according to the classi­ fication of Schatzker, Horne and Wadell. There was 71% excellent and good results, with a signi­ ficant difference between the treatment modalities (54% for orthopaedic treatment and 74% for surgical treatment, p < 0.01). A total of 17 complications was registered (24%): deep infection in 5 cases, residual deformity in 6, anquilosis in 4, and failed fixation in 2 cases. In summary, surgi­ cal treatment of distal femoral fractures shows better results than the orthopaedic treatment. Non-surgical treatment should be reserved for fractures in osteoporotic patients or in those ca­ ses with surgical contraindications.