Functional outcomes of distal femur fractures treated operatively at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Distal femur fractures account for 4% to 7% of all femoral fractures. They cause considerable morbidity and mortality, especially in the elderly. Operative treatment results in early return to function and early range of motion at the knee joint. This prevents knee stiffness. Locally they occur mainly in the young socioeconomically active age group. Functional outcome of treatment of these injuries has however not been studied at Moi Teaching and Referral Hospital. This study aims to fill this gap and add to the body of knowledge. Objective: To assess functional outcomes of treatment of distal femur fractures in adult patients at MTRH. Methods: A hospital based prospective study carried out over twelve months. All patients presenting with distal femur fractures at the orthopaedic trauma wards and clinics at MTRH were studied after meeting ethical considerations. Data was collected using a questionnaire and the Hospital for Special Surgery (HSS) knee scoring tool. Fractures were classified using the AO system, where type A fracture are extra – articular, type B partially articular and type C completely intra – articular. Fractures can be classified as open or close depending on presence of a communicating wound. Functional knee score at 6 months was measured using the modified HSS score where a score of 85 points or more was excellent, 70 – 84 good, 60 – 69 fair and less than 60 was a poor score. Data was analysed using SPSS® version 21. Results: In all fifty seven adult patients were recruited, with a male to female ratio of 1.7:1. Mean age was 34 ± 12.7 years with a range of 21 – 78 years. Patients with type A fractures constituted 52%, type B 11% and type C 37%. Mean functional outcome as measured using the HSS score 6 months after operative treatment for all were good. Patients above 60 years of age had poor outcome, while those below 60 had good outcomes. Type A and B fractures had good outcomes, type C had poor outcomes. Conclusion: Type A and B distal femur fractures were associated with good functional outcomes. Type C distal femur fractures, open distal femur fractures and patients above 60 years of age were associated with poor functional outcomes. Recommendations: Further studies on type C distal femur fractures, Open distal femur fractures and distal femur fractures in the elderly on factors that may improve functional outcomes in these groups of patients.