Abstract
The management of AO/OTA (AO Foundation/Orthopaedic Trauma Association) 33-C3 complex
distal femoral fractures presents challenges for orthopaedic surgeons. The extensile
anterior approach may be an appropriate alternative treatment technique. The purpose
of this systematic review is to (1) evaluate the Olerud approach (extensile anterior
approach) for the treatment of 33-C3 complex distal femoral fractures and (2) evaluate
postoperative patient outcomes. A systematic literature search was performed to retrieve
studies that evaluated the treatment of 33-C3 complex distal femoral fractures. The
PubMed database query resulted in 429 studies. Two reviewers independently reviewed
the studies, of which six were identified. Patient demographics, AO/OTA fracture,
surgical intervention, follow-up duration, clinical outcomes, and postoperative complications
were collected and analyzed. The systematic review included six studies reporting
on 85 patients (43 males and 42 females); the mean patient age was 45 years (range:
16–101 years). The most common cause of injury was road/traffic accident (51 patients).
The mean follow-up time was 26 months (range: 3–72 months). In five studies, the mean
time for union was 5.8 months (range: 2–9 months). The three most commonly reported
complications were infection (seven [8.2%] patients), failure/malunion (three [3.5%]
patients), and delayed tibial tuberosity osteotomy healing (three [3.5%] patients).
Seventy (82.4%) patients did not suffer any postoperative complications. Out of 72
patients, 7 (9.7%) had resultant varus/valgus deformity. Overall, 57.1% had excellent/good
functional outcomes. Based on the systematic literature review, the extensile anterior
approach may be a viable alternative surgical option for 33-C3 complex distal femoral
fractures. Given the current literature, more comprehensive and extensive studies
need to be performed to ensure the best possible outcome.
Keywords
Olerud - 33-C3 fracture - extensile anterior approach - trauma - distal femoral fractures
