Distal femoral fractures constitute about 10- 15% of all fractures of the femur [1]. The optimum treatment for the fractures of the distal femur in adults continues to be debated until today. Till recently it was being managed as an extension of femoral shaft fracture treated with skeletal traction supplemented by manual manipulation of fracture fragments. Stewart MJ et al [2] advocated cast bracing for the management of distal femoral fractures. Relatively recent advances have improved the overall results of the surgical treatment of these fractures. These advancements include improved surgical instrumentation, rigid fixation, improved rehabilitation without postoperative plaster cast immobilization, and immediate postoperative knee movements Connoly J. F, et. Al [3] and Mooney V et al [4].

A new intra-medullary fixation device having a specially shaped rod and a compression screw to conform to the medullary canal of the condyle and distal femoral shaft was advocated by Zickel R E et al [5] This resulted in prevention of late osteoarthritis and elimination of fracture disease. This changing pattern of fracture treatment for a supracondylar fracture of femur prompted us to carry out this study, so as to evaluate the efficacy of various implants and to compare the results of operative treatment of such fractures.

The present study was conducted on 48 patients having fractures of the distal femur (involving distal 15cm of the femur). The cases were picked up from the patients treated at two tertiary care hospitals by open reduction and internal fixation from July 2014 to July 2018. The patients were examined thoroughly to rule out any systemic disease. Routine investigations like Hb, TLC, DLC, PT, APTT, Blood Sugar, and urine examinations were done in all cases. HIV and HBsAgX-ray chest, ECG, Blood Urea, Serum Creatinine, Serum Electrolytes, etc. were done wherever indicated.

Operative procedure: The fractures were exposed through appropriate incision and choice of the implant was done according to the requirement in a particular case depending upon types of fractures. The bone grafts were used in cases where indicated, the wound was closed over the negative suction drain in all cases. For the purpose of analysis, the

Most of the patients were injured while traveling in a moving vehicle either as a passenger or driver. A moving vehicle hit 2 patients while they were walking on the road. One patient sustained the injury following fall after slipping on the ground and one patient sustained an injury from fall from height.

Table-5: Type of fracture

For the purpose of analysis, the fractures were classified according to Schatzker and Lambert's classification.

Table-6: Associated injuries observed

Associated injuries were found in 13 patients.

Table-7: Types of implants used

Table-8: Duration of Hospital stay

Most of the patients were discharged from the hospital within one week.

Table-9: Functional results

various complications associated with this complex fracture.36 out of 48 patients in our series were having either comminuted or inter-condylar T-shaped fractures whereas only 12 patients had a simple supracondylar fracture. High incidence of comminuted and T-shaped fractures could be attributed to increased severity of trauma seen in vehicular accidents. Schatzker J et al [9] (1974) have reported 47 patients out of 55 in their series as having comminuted supracondylar and intercondylar fractures. Similar observations have also been reported by Halpenny J et a1 [10], Yang RS et al [7].

Associated injuries were observed in 13 out of 48 cases in our series (27%). These are obviously due to high-velocity trauma caused by automobile accidents. The incidence of associated trauma reported in the literature varies from 23%-72%. Giles JB et al [11] and Siliski JM et al [6] have reported the incidence of associated injuries to be 23% and 59% respectively in their series. 41 out of 48 patients (85.42%) were discharged from the hospital within 7 days. The remaining 7 patients were discharged within 8-14 days. Earlier reports by various workers mentioned the hospital stay ranging from 20-33 days. Cave E F et al [12] Chiron HS et al [13]. However, with improved facilities for rigid fixation and accurate reduction, the hospital stay can be shortened to a great extent, as has been the case in the present study. In most of the patients, the implant used was either a dynamic condylar screw or a distal femur plate or retrograde nailing for comminuted fractures whenever indicated. In 42 patients full weight-bearing was permitted between 12-24 weeks after the operation (average 19.6 weeks). In one patient full weight-bearing had to be delayed up to 28 weeks because of mal-union and implant failure. In the remaining 5 patients, weight-bearing could not be allowed following primary operation because of infection in 3 patients and implant failure in the other 2 patients. Muller ME et al [14] and Drennan et al [15] have reported full weight-bearing between 8- 14 weeks. 11 patients had excellent results. The results were graded as good in 12 patients and in 11 patients, the result was graded as fair. 14 out of 48 patients in this series were graded as poor. EJ Yeap et al in a retrospective review of 11 patients treated for type A and C distal femoral fracture with distal femoral locking compression plate reported almost 80% good results in terms of union and function [16]. The result of the study by Lauri Handolin et al also suggested that retrograde nailing may be used