Background: The treatment of open severe comminuted fractures of the distalFemur is still a major problem. The basic strategy is to assemble the condylar fragments and then fix the condyles to the femoral Shaft by minimal handling of the soft tissues.Objectives: To evaluate the treatment of open severe comminuted fractures of the Distal Femur (type C2 and C3) with hybrid external fixator.Methods: Thirty-four patients with open comminuted distal femur fracture (type C2 and C3) were treated by hybrid external fixator between January 2005 and December 2008. Average follow up period was 36 months. All of the fractures were opened and extended to joint surface. 30 patients were male and 4 were female. Their average age was 30.5 years (17 to 72y). 12 patients had isolated fracture and 22 patients had multiple fractures. The bony and functional results were evaluated by A.S.A.M.I protocol and knee society score.Results: Twenty nine out of 34 fractures (85%) had union without bone grafts. Ave-rage time of union was 6.1 months (4-19 ms). 27 patients had union within 6 months or less. The average knee range of motion was 87.5 degrees (30-115 degrees).According to the association for the study and application of the method of Ilizarov (ASAMI) protocol, the bony results were excellent in 24 patients (70.5%), good in 6 (17.7%), fair in 2 (5.9%), and poor in 2 (5.9 %), and the functional results were excellent in 10 (29.4%) patients, good in 14 (41.2%), fair in 6 (17.6%), and poor in 4(11.8%).According to the knee society score the functional results were excellent in 9(26.44%) patients, good in 13(38.26%), fair in 7(20.6%), and poor in 5(14.7%).Conclusion: Hybrid external fixator is an effective method for treatment of open severe comminuted fractures of the distal Femur (type C2 and C3) and may be considered an alternative to other conventional surgical methods in the management of these fractures.
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