A comparative study between swashbuckler approach (Modified Anterior Approach) and lateral approach for the distal femur fractures

Abstract

Background: Distal femur fractures with intra-articular extension and comminution are challenging injuries, fraught with complications such as mal-union and stiffness. We prospectively evaluated and compared a consecutive series of patients with AO type B and C distal femur fractures to determine the clinico-radiological outcome after fixation with distal femur locking compression plate using Swashbuckler approach and standard lateral approach. Materials and Methods: 60 patients with AO Muller's type B and C distal femur fractures (mostly type C2 and C3) were treated with distal femur locking compression plate (DF-LCP), 30 patients using swashbuckler approach and 30 patients using standard lateral approach. The regular follow-up up to 1 year was done and results were determined using the Neer’s Score. Results: All fractures united at a mean of 14.64 weeks (range 12-20 weeks). In our study mean duration of surgery for lateral approach group was greater (99.6min) than swashbuckler group (85 min). Mean ROM in swashbuckler group was 100.83 degree compared to 83.83 in lateral group. Mean Neer’s score was 76.96 in lateral approach group compared to 81.83 in swashbuckler approach group. Complication rate was similar in both the group. Conclusion: The results of distal femur fractures using a swashbuckler approach are encouraging and comparable to standard lateral approach with a majority of patients achieving good to excellent outcome at 1 year especially in complex AO type C3 fractures.