دوشنبه 2 شهریور 1405
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Open distal femur fractures are uncommon but challenging injuries often resulting from high-energy trauma and associated with high complication rates including infection and nonunion (1,12). We present a 20-year-old male with an open comminuted (AO/OTA type 33-C3) distal femur fracture and extensive soft tissue injury including lateral collateral ligament and patellar tendon rupture. The patient was treated with a two-stage approach: initial irrigation, debridement, and external fixation followed by definitive open reduction and internal fixation (ORIF) with locking plate, autologous bone grafting, and polypropylene mesh augmentation, along with ligamentous repair. At 8 weeks, the patient achieved a stable knee and improved range of motion without complications. This case highlights that mesh augmentation can be a useful adjunct in managing bone loss in high-energy distal femur fractures (5,14–16) and emphasizes the importance of early soft tissue repair in restoring knee function (2,9)
فهرست منابع
1. Maley DK, Singh R, Khiyani R, Kaur K. Evaluation of results of open distal femur fractures with primary fixation and antibiotic impregnated collagen. Chin J Traumatol. 2019;22(6):328-32. [DOI:10.1016/j.cjtee.2019.08.005] [PMID] [PMCID]
2. Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res. 2013;99(3):353-60. [DOI:10.1016/j.otsr.2012.10.014] [PMID]
3. Zhu C, Zhang J, Li J, Zhao K, Meng H, Zhu Y, et al. Incidence and predictors of surgical site infection after distal femur fractures treated by open reduction and internal fixation: a prospective single-center study. BMC Musculoskelet Disord. 2021;22:258. [DOI:10.1186/s12891-021-04132-9] [PMID] [PMCID]
4. Irigoyen MC, Bidolegui F, Pereira S. Fractures of the distal femur associated with a complete quadricipital tendon injury: report of two cases. Rev Asoc Argent Ortop Traumatol. 2022;87(2):238-45. [DOI:10.15417/issn.1852-7434.2022.87.2.1502]
5. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39(12):1338-44. [DOI:10.1016/j.injury.2008.06.021] [PMID]
6. Siwek CW, Rao JP. Ruptures of the extensor mechanism of the knee joint. J Bone Joint Surg Am. 1981;63(6):932-937. [DOI:10.2106/00004623-198163060-00010]
7. Dugan TR, Hubert MG, Siska PA, Pape HC, Tarkin IS. Open supracondylar femur fractures with bone loss in the polytraumatized patient: timing is everything. Injury. 2013;44(12):1826-31. [DOI:10.1016/j.injury.2013.03.018] [PMID]
8. Masquelet AC, Fitoussi F, Begue T, Muller GP. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet. 2000;45(3):346-53.
9. Taylor BC, Hancock J, Zitzke R, Castaneda J. Treatment of bone loss with the induced membrane technique: techniques and outcomes. J Orthop Trauma. 2015;29(12):554-57. [DOI:10.1097/BOT.0000000000000338] [PMID]
10. Karger C, Kishi T, Schneider L, Fitoussi F, Masquelet AC. Treatment of posttraumatic bone defects by the induced membrane technique. Orthop Traumatol Surg Res. 2012;98(1):97-102. [DOI:10.1016/j.otsr.2011.11.001] [PMID]
11. Kalantar SH, Saffar H, Hoveidaei AH. Bone reconstruction with modified Masquelet technique in open distal femoral fractures: a case series. BMC Musculoskelet Disord. 2024;25(1):26. [DOI:10.1186/s12891-023-07091-5] [PMID] [PMCID]
12. Ma XY, Yuan H, Cui D, Liu B, Han TY, Yu HL, et al. Management of segmental defects post open distal femur fracture using a titanium cage combined with the Masquelet technique: a single-centre report of 23 cases. Injury. 2023;54(12):111130. [DOI:10.1016/j.injury.2023.111130] [PMID]
13. Vosoughi F, Vosoughi F, Kalantar SH. Open knee dislocation, triple intra-articular fractures and patellar tendon rupture: a case report of a knee disaster treated with aggressive irrigation/debridement, early anatomic reduction and internal fixation. BMC Musculoskelet Disord. 2022;23:431. [DOI:10.1186/s12891-022-05268-y] [PMID] [PMCID]
14. Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL. Midshaft and distal femur fracture fixation: a biomechanical comparison of locked plating and intramedullary nailing. J Orthop Trauma. 2010;24(10):567-575.
15. Jaramillo Quiceno GA, Sarmiento Riveros PA, Arias Perez RD, Soto Gomez MP, Ramirez AO. Augmentation in the repair of traumatic patellar tendon ruptures: a novel mechanical and biological construct (Technical note). J ISAKOS. 2023;8(2):122-127. [DOI:10.1016/j.jisako.2022.10.003] [PMID]
16. Nodzo SR, Rachala SR. Polypropylene mesh augmentation for complete quadriceps rupture after total knee arthroplasty. Knee. 2016;23(1):177-180. [DOI:10.1016/j.knee.2015.09.007] [PMID]
17. Powell C, Sanders K, Huang N, Colón LF, Norton C. Distal femoral replacement and extensor mechanism repair reinforced with synthetic mesh for distal femur fracture with patellar ligament avulsion: a case report. Arthroplasty Today. 2022;16:31-38. [DOI:10.1016/j.artd.2022.04.001] [PMID] [PMCID]
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