Analysis of functional outcomes and PROMs after internal fixation of intra-articular distal femur fracture

Intra-articular distal femur fractures are complex injuries that present a significant challenge to orthopaedic surgeons. They have bimodal distribution—affecting young males through high-velocity trauma and elderly females through low-energy falls. Restoration of articular congruity and stable internal fixation are essential to achieve optimal functional outcomes. This study aims to evaluate the functional outcomes, PROMs and complications following internal fixation of intra-articular distal femur fractures. This was a prospective observational study conducted at AIIMS Raipur between November 30, 2021, and May 29, 2023, including 30 patients aged over 18 years with AO33B and AO33C distal femur fractures. Patients underwent open reduction and internal fixation using various implant configurations, including distal femur locking compression plate with or without medial augmentation plate. Functional outcomes were assessed using the Knee Society Score, a PROM at 3 and 6 months post-operatively. Statistical analysis included Chi-square and Student’s t-tests, with significance set at p<0.05. Of the 30 patients (mean age 41.23±16.62 years), 73.3% were male and 80.0% sustained injuries from road traffic accidents. AO33C fractures accounted for 56.7% of cases. A distal femur locking compression plate was the most commonly used implant (60.0%). The mean surgery duration was 101.0±29.98 minutes, and the mean time to union was 12.0±2.78 weeks. A range of motion ≥100° was achieved in 66.7% of patients. Overall, 66.7% had excellent outcomes, 23.3% good, and 10.0% fair. Stiffness was the most common complication (26.7%). Significant associations with functional outcome were observed for fracture type, injury-surgery interval, and postoperative complications (p<0.05), while implant type, age, and gender were not significantly associated. Stable fixation of intra-articular distal femur fractures with maintenance of articular congruency provides satisfactory functional outcomes, particularly when performed early. AO33B fractures had better outcomes than AO33C. There is no significant difference between single and dual plating regarding nonunion, functional outcomes, or complications. Despite radiological union, residual functional impairments may persist, emphasizing the importance of comprehensive post-operative care and early rehabilitation. Individualized treatment planning remains essential for optimal recovery.