Study of fracture fixation ability under trial and treatment outcomes of closed distal femur fracture of locking plate in adult patients

rcus locking plate. - Compression and horizontal and torsion bendings experiment was performed on 02 models: LCP model: LCP – cow femur (symbol: K). Condyle plate model - cow femur (symbol: L) - Plate - bone model design: cow’s DFF were sawed to form supra-condyle (type A2) and inter-condyle fractures (type C2) according to AO classification. Bones were adjusted. Plate/screw systems were placed on lateral aspect of the bones, plates were clamped with bone pliers. Drilling was implemented to insert screws to fix plates to bones (full screws were inserted to holes in plate). - Trial machine: Compression, bending and torsion trials were performed by MTS Alliance RF/300 machine. Working principle: The encorders of the machine would measure compressive, horizontal and torsion bendings forces acting on the models while measuring the corresponding deformation level of the models along the axis of acting force. The compressive, bending, torque and deformation parameters at the fracture were continuously measured and transmitted to a computer. The computer would automatically build a graph showing the relationship between force - deformation of the models. From the graph, we could calculate force-bearing level of the models. * Study content : Axial compressive force, Horizontal bending forc Torsional bending force * Method of evaluating the result: A graph was drawn and average values of forces acting on the two study sample were calculated by statistical algorithms of Hanoi University of Science and Technology. Average values (Independent Sample T test) and medians of forces acting on two samples were compared. 2.2. Study on treatment outcomes of DFF closed fracture using locking plate osteosynthesis. * Material: 54 patients (26 men, 28 women), with age ranging from 18 - 90 years old and having DFF closed fracture caused by trauma, received locking plate osteosynthesis at Duc Giang hospital, Xanh Pon hospital, Military hospital 103 from June 2011 - 9/2015. * Inclusion criteria: Patients with DFF closed fracture type A and C caused by trauma. * Clinical study method - Method: longitudinal, non-controlled, descriptive study. - Process: Collecting study records. Examinating patients. Preparing patient before surgery. Do surgerical interventions and surgical records. Doing post-operative care and X-ray examination. Assessing near outcomes: outcomes of reduction and osteosynthesis after surgery and process of incision. Patients was guided to do rehabilitation. Follow-up sheet was made for each patient. Patients was appointed to re-examine at following times: 1, 2, 3, 4, 5, 6 and 12 months after surgery and far outcomes (> 12 months) was aslo assessed. - Content: Epidemiological characteristics. Cause and mechanism of trauma. Taking X-rays before and after surgery, until bone healing occured. Classification of DFF fracture based on X-ray images according to AO classification. Surgical techniques, Locking plate osteosynthesis indication, treatment outcomes. * Treatment of DFF closed fracture using locking plate osteosynthesis - Anesthesia: spinal anesthesia. - Surgical technique: patient’s position: patients were on supine position with supporters below poplitei and tourniquets of thigh. Phase 1: Incision: lateral incision for simple DFF fractures and lateral anterior incision for complicated fractures, joint fracture and difficult reduction. Phase 2: Exposure and reduction of fracture Phase 3: Placement of locking plate Phase 4: Closing the incision * Post-operative treatment: After surgery, patient’s leg would put on the Braun .Antibiotics were used for 5-7 days, combining analgesics, anti-edema after surgery. Band was replaced and drainage was done after 48 hours. * Movement practice after surgery: patients were guided to move early: On the second day after surgery, patients sat up, and practiced quadriceps muscle contraction and knee joint flexion and extension. After 2-3 weeks, patient practiced to stand, walk with two crutches. After 4 - 6 weeks, patient practiced to walk with a crutch, then after 6 to 8 weeks patient practiced to walk with no crutch. * Method of outcome assessment * Assessment of near outcome: According to standard of Larson - Bostman: incision process: First phase healing or superifical and deep infections. Reduction outcome recovering anatomy and osteosynthesis technique. Early complications (Bleeding, thrombosis, embolism). * Assessment of far outcome: Follow-up for at least 12 months. We used assessment method of Sanders R. (1991). Assessment of outcomes by 4 levels: Very good, good, average and poor. * Methods of data processing: According to the medical statistics program SPSS 20.0. Comparison between average values of study groups (Independent Sample T test). Chapter 3. RESULT 3.1.Results of trial study on mechanical strength and rigid fracture fixation for DFF fracture of locking plate. 3.1.1. Compressive strength trial on 2 samples: DFF locking plate - bone (KA - N) and condyle plate - bone (LA - N). Table 3.1: Compressive forces bearing ability on 2 samples of femoral supra-condyle fracture (KA - N) and (LA - N) (n = 12) Compressive force Fracture displacement Plate – bone sample with femoral supra-condyle fracture P KA – N (`X ± SD) (Newton - N) (n=6) KA – N (Median - N) LA – N (`X ± SD) (Newton - N) (n=6) LA – A (Median - N) 0.5 mm 1329.90 ± 355.90 1281.21 1121.19 ± 230.17 1115.48 > 0,05 1.0 mm 1719.48 ± 384.83 1789.93 1552.09 ± 256.04 1611.70 > 0,05 1.5 mm 2456.16 ± 641.66 2641.24 2074.99 ± 263.24 2113.90 > 0,05 2.0 mm 3225.50 ± 427.18 3293.35 2865.01 ± 548.70 2814.24 > 0,05 2.5 mm 4010.37 ± 509.50 4179.34 3200.04 ± 243.62 3118.63 < 0,05 Comment: From displacement of 2.5 mm, there was a significant change and difference of forces acting on sample (KA - N): 4010.37 ± 509.50N (median: 4179.34N) and on sample (LA - N): 3200.04 ± 243.62N (median: 3118.63N) with the same femoral fracture model, with p < 0.05. Graph 3.1. Correlation between compressive force and deformation of 2 samples (KA - N) and (LA - N) with femoral supra-condyle fracture Comment: The graph showed that average compressive force on DFF locking plate - bone samples was 4179.34N with fracture displacement of 2.5mm began to break connection, while average compressive force on the femoral condyle plate - bone samples was 3118.63N with fracture displacement broken connection, with p < 0.05. Table 3.2. Compressive forces bearing ability on 2 samples of femoral inter-condyle fracture (n=12) Compressive force Fracture displacement Plate – bone sample with femoral inter-condyle fracture P KC – N (`X ± SD) ( Newton - N) (n=6) KC – N (Median - N) LC – N (`X ± SD) (Newton - N) (n=6) LC – N (Median - N) 0.5 mm 1194.51 ± 210.07 1184.63 953.97 ± 287.56 995.22 > 0.05 1.0 mm 2030.63 ± 241.84 2028.99 1597.88 ± 527.67 1686.33 > 0.05 1.5 mm 3140.14 ± 288.16 3228.73 2738.34 ± 703.88 2919.65 > 0.05 2.0 mm 3915.8 ± 295.43 3968.29 3498.13 ± 787.61 3524.11 > 0.05 2.5 mm 4620.27 ± 315.85 4728.87 4139.28 ± 766.53 4322.23 > 0.05 Comment: From displacement of 2.5mm, there was a change and difference of forces acting on the sample (KC - N): 4620.27 ± 315.85N (median: 4728.87N) and on sample (LC - N): 4139.28 ± 766.53N (median: 4322.23N) on femoral inter-condyle fracture model, which was not significant with p > 0.05. Graph 3.2. Correlation between compressive force and deformation of 2 samples (KA - N) and (LA - N) with femoral inter-condyle fracture Comment: The graph showed that average compressive force on DFF locking plate - bone samples of 4728.87N with fracture displacement of 2.5mm began to break connection, while average compressive force on the femoral condyle plate - bone samples was 4322.23N with fracture displacement of 2.5mm also began to break connection, the difference in force was not statistically significant with p> 0.05. Comment: femoral condyle plate - bone sample showed that the axial force bearing ability was lower than that of DFF locking plate - bone system. 3.1.2. Trial of horizontal bending strength on samples of DFF locking plate - bone sample (KA - U) and femoral condyle plate - bone (LA - U). Table 3.3. Horizontal bending strength on samples of (KA - U) and (LA - U) with femoral supra-condyle fracture (n=12) Horizontal bending force Fracture displacement Plate – bone sample with femoral supra-condyle fracture P KA – U (X ± SD) (Newton - N) (n=6) KA – U (Median - N) LA – U (X ± SD) (Newton - N) (n=6) LA – U (Median - N) 1 mm 204.94 ± 70.34 178.04 155.86 ± 48.13 136.84 > 0,05 2 mm 396.37 ± 117.52 365.62 314.52 ± 88.88 340.30 > 0,05 3 mm 537.79 ± 121.16 508.07 499.78 ± 85.32 484.7 > 0,05 4 mm 704.33 ± 110.45 704.08 505.76 ± 62.83 505.82 < 0,05 Comment: From displacement of 4 mm, when broken connection began happening, horizontal bending force acting on the sample (KA - U): 704.33 ± 110.45N (median: 704.08N) was higher than that of the sample (LA - U): 505.76 ± 62.83N (median: 505.82N), with p < 0.05. Graph 3.3. Correlation between horizontal bending force and deformation of samples of (KA - N) and (LA - N) with femoral supra-condyle fracture Comment: Average horizontal bending forces of 704.08N and 505.82N acting on DFF locking plate – bone and femoral condyle plate – bone samples respectively caused broken connection (displacement of 4 mm), with p < 0.05. Table 3.4. Horizontal bending strength on samples of (KA - U) and (LA - U) with femoral inter-condyle fracture (n=12) Horizontal bending force Fracture displacement Plate – bone sample with femoral inter-condyle fracture P KC - U (`X ± SD) ( Newton - N) (n=6) KC – U (Median - N) LC - U (`X ± SD) ( Newton - N) (n=6) LC – U (Median - N) 1 mm 139.43 ± 39.09 137.38 105.3 ± 35.22 99.65 > 0,05 2 mm 271.34 ± 124.77 343.84 216.28 ± 97.57 226.3 > 0,05 3 mm 447.57 ± 107.14 499.22 416.75 ± 134.66 376.7 > 0,05 4 mm 699.26 ± 125.60 715.89 476.05 ± 59.18 492.44 < 0,05 Comment: From displacement of 4 mm, when broken connection began happening, the force acting on the sample (KA - U): 699.26 ± 125.60N (median: 715.89N) had significant differences with that of the sample (LA - U): 476.05 ± 59.18N (median: 492.44N), with p < 0.05. Graph 3.4. Correlation between horizontal bending force and deformation of samples of (KA - N) and (LA - N) with femoral inter-condyle fracture. Comment: The graph showed that average horizontal bending forces of 715.89N and 492,44N acting on DFF locking plate – bone and femoral condyle plate – bone samples respectively caused broken connection (displacement of 4 mm). The difference was statistically significant with p < 0.05. Comment: bending stiffness of locking plate (K) was much higher than that of condyle plate (L) on samples. Concurrently, locking plate (K) also had a higher horizontal bending strength. 3.1.3. Trial of torsional bending strength on samples of DFF locking plate - bone (KA - X) and femoral condyle plate - bone(LA- X). Table 3.5: Torsional bending strength on samples of (KA - X) and (LA - X) with femoral supra-condyle fracture (n=12) Torsional bending force Fracture displacement Plate – bone sample with femoral supra-condyle fracture P KA – X (`X ± SD) (Newton - N) (n=6) KA – X (Median - N) LA – X (`X ± SD) (Newton - N) (n=6) LA – X (Median - N) 1 mm 421.64 ± 54.73 429.33 390.70 ± 81.15 419.76 > 0,05 2 mm 589.57 ± 88.51 608.27 533.90 ± 95.10 559.96 > 0,05 3 mm 777.02 ± 134.66 809.40 686.91 ± 80.48 699.84 > 0,05 4 mm 990.79 ± 166.54 991.69 888.84 ± 89.02 905.38 > 0,05 Comment: From displacement of 4 mm, when broken connection began happening, the force acting on the DFF locking plate – bone sample of 990.79 ± 166.54N (median: 991.69N) had a difference with that of femoral condyle plate – bone sample of 888.84 ± 89.02N (median: 905.38N) on the same femoral supra-condyle fracture model, with p < 0.05. Graph 3.5. Correlation between torsional bending force and deformation of samples of (KA - N) and (LA - N) with femoral supra-condyle fracture. Comment: The graph showed that average horizontal bending forces of 991.69N and 905.38N acting on DFF locking plate – bone and femoral condyle plate – bone samples respectively caused broken connection (displacement of 4 mm). The difference wasn’t statistically significant with p > 0.05. Table 3.6. Torsional bending strength on samples of (KA - X) and (LA - X) with femoral inter-condyle fracture (n=12) Torsional bending force Fracture displacement Plate – bone sample with femoral inter-condyle fracture P KC – X (`X ± SD) ( Newton - N) (n=6) KC – X (Median - N) LC – X (`X ± SD) ( Newton - N) (n=6) LC – X (Median - N) 1 mm 514.21 ± 135.30 538.79 489.13 ± 81.64 464.88 > 0.05 2 mm 707.42 ± 213.60 691.70 664.43 ± 98.04 622.82 > 0.05 3 mm 829.03 ± 162.50 845.21 826.02 ± 112.04 785.43 > 0.05 4 mm 1071.00 ± 222.38 1091.79 986.26 ± 116.33 972.38 > 0.05 Comment: From displacement of 4 mm, when broken connection began happening, the force acting on the DFF locking plate – bone sample of 1071.00 ± 222.38N (median: 1091.79N) had a difference with that of femoral condyle plate – bone sample of 986.26 ± 116.33N (median: 972.38N), with p > 0.05. Graph 3.6. Correlation between torsional bending force and deformation of samples of (KA - N) and (LA - N) with femoral inter-condyle fracture. Comment:The graph and calculation results showed that the converted stiffness of femoral condyle plate – bone system was less than 5% lower than that of DFF locking plate – bone system, however the limited force value of DF locking plate – bone system reached 1850N while that of femoral condyle plate – bone system was only about 1450N (lower than 27.58%). This showed that DFF locking plate system had the same stiffness but higher force-bearing limit than that of femoral condyle plate system. 3.2. Treatment outcomes of DFF closed fracture using locking plate osteosynthesis 3.2.1. Characteristics of studied patient group Age and gender: Average age: 51.04 ± 22.30 years old (18 - 90 years old), male to female ratio: Male 26 patients (48.15%); Female 28 patients (51.85%). Elderly group ≥ 60 years old: 26 patients (48.15%), group with age from 18 - 44 years old: 20 patients (37.04%), group of 45 - 59 years old: 8 patients (14.81%). 3.2.2. Accident’s causet: Daily activities accidents accounted for the highest rate with 27 patients (50%), 24 patients with traffic accident was (44.44%) and 3 people had labor accident (5.56%). 3.2.3. Trauma mechanism: Direct and indirect mechanism had same rate (50%). 3.2.4. Location, morphology and nature of injury * Affected-side of thigh Left DFF fracture of 30 patients (55.56%) was more than the right fractur of 24 patients (44.44%). * Nature of the fracture: Simple fracture: 31 patients (57.41%), complex fracture: 23 patients (42.59%). 3.2.5. Classification of fracture according to AO Table 3.10. Classification of fracture according to AO (n = 54) Fracture type Type A Total Type C Total A1 A2 A3 C1 C2 C3 Number of patients 16 22 4 42 3 7 2 12 Rate (%) 29.63 40.74 7.41 77.78 5.56 12.96 3.7 22.22 Table 3.11. Classification of fractures by cause of accident (n = 54) Cause Fracture type Traffic accident Labor accident Daily activities accident Total Rate (%) Type A 18 2 22 42 77.78 Type C 6 1 5 12 22.22 Total 24 3 27 54 100 Rate (%) 44.44 5.56 50.0 100 3.2.6. Soft tissue injury 100% of patients had DFF closed fracture. No patient had open fracture. 3.2.7. Accompanied injuries Brain injury: 5 patients, chest injury: 2 patients, other fractures: 11 patients. 3.2.8. Blood vessel and nerve injuries There was no person with blood vessel and nerve injuries. 3.2.9. Surgical intervention with locking plate osteosynthesis 3.2.9.1. Period of surgery : 1st day: 32 patients (59.26%), 2nd – 6th day: 14 patients (25.93%), > 7 days: 4 patients (14.81%). 3.2.9.2. Anesthesia method: spinal anesthesia. 3.2.9.3. Incision: Anterolateral incision 32 patients (59.26%), lateral incision: 22 patients (40.74%). 3.2.9.4. Surgical duration Surgery duration from 60 - 90 minutes (87.04%), type A: 39 patients, type C: 8 patients. Surgery duration from 90 - 120 minutes: 5 patients (9.26%), both surgery durations of 120 - 150 minutes and 150 - 180 minutes had 1 patient (1.85%). 3.2.9.5. Osteosynthesis with locking plate combined with other osteosynthesis measures: Using porous screw with locking plate: 12 patients (22.22%), porous screw with steel sutures and locking plate: 2 patients (3.70%). 3.2.9.6. Number of transfusion There were 36 patients receiving transfusion with total blood volume of 18200 ml. 19 patients were transfused 500 ml of blood, 11 patients were transfused 250 ml of blood, 1 patient was transfused 750 ml of blood. Patients who were transfused more blood were who had with poly-trauma or internal-organ trauma 3.2.10. Treatment outcome 3.2.10.1. Near outcome: * Incision: first phase incision healing: 53 patients (98.15%), superficial infection: 1 patient (1.85%). There was no patient with deep infection or bleeding after surgery. * Reduction outcome: Non-displacement: 50 patients (92.59%), less displacement: 4 patients (3.70%). * Bone healing outcome Table 3.18. Duration of bone healing (n = 54) Group age Duration of bone healing (week) Min - Max P 18 – 30 14.39 ± 1.98 (12 – 18) < 0,05 31 – 40 16.50 ± 4.95 (13 – 20) 41 – 50 17.00 ± 1.16 (16 – 18) 51 – 60 19.50 ± 1.76 (18 – 22) 61 - 70 20.33 ± 1.92 (18 – 23) > 70 22.42 ± 2.28 (20 – 26) Comment: Average bone healing duration: 18,33 ± 3,78 weeks (12 - 26 weeks), younger people had bone healing faster than elderly people, the difference with statistical significance with p < 0.05. * Result of rehabilitation Table 3.19. Time to remove crutches (n = 54) Group age Time to remove crutches (week) Min - Max p 18 – 30 4.42 ± 0.58 (4,00 – 6,00) < 0.05 31 – 40 4.50 ± 0.71 (4,00 – 5,00) 41 – 50 4.75 ± 0.65 (4,00 – 5,50) 51 – 60 4.25 ± 0.27 (4,00 – 4,50) 61 – 70 5.50 ± 0.71 (4,50 – 6,50) > 70 6.83 ± 1.01 (5,00 – 8,00) Comment: Average time to remove crutches: 5.20 ± 1.19 weeks (from 4 to 8 weeks). The group of young people removed crutches earlier than the elderly, the difference was statistically significant with p <0.05. Table 3.20. Normal-walking time (n = 54) Group age Normal-walking time (months) Min - Max p 18 – 30 3.67 ± 0.73 (2.50 – 4.50) < 0.05 31 – 40 4.50 ± 1.41 (3.50 – 5.50) 41 – 50 4.25 ± 0.87 (3.50 – 5.50) 51 – 60 5.33 ± 0.52 (5.00 – 6.00) 61 - 70 4.88 ± 0.53 (4.00 – 5.50) >70 5.58 ± 0.79 (4.50 – 6.50) Comment: Average normal-walking time: 4.62 ± 1.03 months (from 2.5 to 6.5 months). The group of young people walking normally faster than the elderly group, the difference was statistically significant with p < 0.05. 3.2.10.2. Far outcome * Far outcome follow up: Average follow up time: 34.58 ± 8.38 months (12 – 48 months), far outcome follow up: 38/54 patients (70.37%). * Surgical scar: Surgical scar was soft and not inflamed: 36 patients (94.7%). Hypertrophic scars: 2 patients (5.3%). * Result of rehabilitation - Pain: 28 patients with no pain (73,68%). 10 patients sometimes had pain (26,32%). - Knee flexion degreet: Knee flexion degree ≥ 1250 : 22 patients (57.89%), 1000 - 1240 : 12 patients (31.58 %), from 900 - 990 : 4 patients (10.53%), there was no case < 900 - Knee extension degree: 36 patients with knee extension degree to 00 (94.74%), 2 patients with knee extension degree 50 - Ankle joint movement: 35 patients with normal ankle joint movement (92.11%), 3 patients with limited ankle joint movement (7.89%). No case of ankylosis. - Limb deformation + Folding deformation: 34 patients had no folding deformation (89.47%), 4 patients had folding deformation 100 + Short limbs: In our study, there were no case of short limbs. + Ability to walk after surgery:Walking as normal: 31 patients (81.58%), walking from 30 – 60 minutes: 7 patients (18.42%). + Ability to go up stairs:Ability to go upstairs as normal: 28 patients (73.68%), using handrail 10 patients (26.32%). + Ability of working and doing daily activities:27 patients (young people worked and elderly did daily activities normally - 71.05%); 7 patients (young people worked hard and elderly people needed to be supported partly – 18.42%). There were 4 patients (young people had to change previous jobs and elderly people had be supported with living activities - 10.53%). 3.2.10.3. Far outcome after surgery * Assessment of far outcome according to AO fracture classification Table 3.30. Assessment of far outcome according to AO fracture classification (n = 38) Result Group A Group C Total Rate % A1 A2 A3 + C1 C2 C3 + Very good 8 6 4 18 - 3 1 4 22 57.89 Good 1 7 - 8 2 2 - 4 12 31.58 TB - - - - 1 2 1 4 4 10.53 Poor - - - - - - - - - - Total 9 13 4 26 3 7 2 12 38 100 Comment: Type A: Very good: 18 patients (47.36%), good: 8 patients (21.05%), Type C: Very good 4 patients (10.53%), good: 4 patients (10.53%), average: 4 patients (10.53%) * Assessment of common outcome: Comment: Very good 57.89%, good: 31.58%, average: 10.53%, poor: 0 patient. Chapter 4 DISCUSSION 4.1. Rigid fracture fixation ability rigid DFF fracture of locking plate * Compressive strength of DFF locking plate – bone sample: From displacement of 2.5mm on femoral supra-condyle fracture model, the forces acting on the DFF locking plate – bone and femoral condyle plate – bone samples were 4010.37 ± 509.50N (medium 4179.34N) and 3200.04 ± 243.62N (Median 3118.63N) respectively. The difference was statistically significant with p 0.05 * Horizontal bending strength of DFF locking plate – bone sample: From displacement of 4 mm, when broken connection began happening on plate – bone sample with femoral supra-condyle fracture, the forces acting on the DFF locking plate – bone and femoral condyle plate – bone samples were 704.33 ± 110.45N (median: 704.08N) and 505.76 ± 62.83N (median: 505.82N) respectively, the difference was statistically significant with p < 0.05. From displacement of 4 mm, when broken connection began happening on plate – bone sample with femoral inter-condyle fracture, the forces acting on the DFF locking plate – bone and femoral condyle plate – bone samples were 699.26 ± 125.60N (Median: 715.89N) and 476.05 ± 59.18N (Median: 492.44N) respectively, the difference was statistically significant. * Torsional bending strength of DFF locking plate – bone sample: From displacement of 4 mm, when broken connection began happening on plate – bone sample with femoral supra-condyle fracture, the forces acting on the DFF locking plate – bone and femoral condyle plate – bone samples were 990.79 ± 166.54N (median: 991.69N) and 888.84 ± 89.02N (median: 905.38N) respectively, the difference wasn’t statistically significant with p > 0.05. From displacement of 4 mm, when broken connection began happening on plate – bone sample with femoral inter-condyle fracture, the forces acting on the DFF locking plate – bone and femoral condyle plate – bone samples were 1071.00 ± 222.38N (median: 1091.79N) and 986.26 ± 116.33N (median: 972.38N) respectively, the difference wasn’t statistically significant with p > 0.05. . 4.2. Treatment outcome of DFF closed fracture using locking plate osteosynthesis 4.2.1. Common characteristics of studied group * Age, gender: There were 54 patients with DFF closed fracture, average age: 51.04 ± 22.30 years old (18 - 90 years old), male: 26 patients (48.15%); female: 28 patients (51.85%), male to female ratio was nearly equal. Elderly group ≥ 60 years old: 26 patients (48.15%), group with age from 18 - 44 years old: 20 patients (37.04%), group of 45 - 59 years old: 8 patients (14.81%). * Cause and mechanism of trauma: Daily activities accident: 27 patients (50%), elderly group ≥ 60 years old: 18/27 people, group of 18 - 44 years old: 4/27 people and group of 45 - 59 years old: 5/27 people. Traffic accident: 24 patients (44.44%), group of 18 - 44 years old: 15/24 people, group ≥ 60 years old: 6/24 people and group of 45 - 59 years old: 3/24 people. Labor accident: 3 patients (5.56%), all of them were young people. Number of patients with left and right DFF fracture were 30 (55.56%) and 24 (44.44%) respectively. * Characteristics, natures and classification of fracture: Simple fracture: 31 patients (57.41%), complex fracture: 23 patients (42.59%). Non-articular fracture: 42 patients (7