Treatment Of Type C Fractures Of The Distal Femur Via The New Anterolateral Approach: Anatomy And Clinical Application

Objective：To study the security, effectiveness and practicality of a newanterolateral approach in the treatment of type C distal femoral fractures (classifiedby Müeller).Methods：1, Anatomy study: main anterolateral muscles, ligaments wereobserved on12lower limbs of adult cadavers; the new anterolateral approach wasused, and the vessels, nerves relative to the posterolateral approach were measuredtoo.2, Clinical study: The clinical data of51patients with type C distal femoralfractures collecting from January2008to August2011were retrospectively analyzed.Of51patients,24patients used the new anterolateral approach combined withfixation of condylar buttress plate (new approach group), and27patients underwenttraditional lateral or anterolateral approach combined with fixation of condylarbuttress plate (traditional approach group). The time of operation, intraoperativeblood loss, frequency of intraoperative fluoroscopy, hospitalization days, fracturehealing time and Hospital for Special Surgery (HSS) scores at3,6, and12months ofknee were recorded.Results：1, Anatomy study:(1) Full exposure of the distal femur was achieved.The iliotibial band was protected, and damage to the quadriceps femoris was reduced.(2) The distance between the common peroneal nerve and the new incision line at thelevel of the lateral epicondyle of the femur was (χ±s)8.19±0.79cm (range,7.48–9.57cm).2, Clinical study: The operation was successfully completed and theincision was healed in all patients. The time of operation and frequency ofintraoperative fluoroscopy of new approach group were significantly less than thoseof traditional approach group (P<0.05). But the intraoperative blood loss and thehospitalization days showed no significant difference between2groups (P>0.05). Allpatients were followed up12-37months (mean,21.3months). X-ray films showed allfractures were union. The fracture healing time was (12.92±2.24) weeks in the newapproach group and (13.24±2.52) weeks in the traditional approach group, showing no significant difference (t=0.476, P=0.637). The knee HSS scores of new approachgroup at3,6, and12months were significant higher than traditional approach groupamong different time points after operation (P<0.05). There was no significantdifference in the incidence of Knee varus or valgus, Change of length, internalfixation loosening, Flexing dysfunction of knee and Traumatic arthritis of kneebetween2groups (P>0.05). There was no significant difference in the incidence oftotal complications between2groups (P>0.05) too.Conculsion：The treatment of type C distal femoral fractures by the newanterolateral approach has the advantages of safety, less damage to soft tissue,excellent exposure and better postoperative rehabilitation of knee joint. it is worth ofspreading.