Results of Early Manipulation Under General Anesthesia in Intra-Articular Distal Femur Fractures

Background: Postoperative knee stiffness after intra-articular distal femur fracture causes significant disability affecting daily activities of the patient and causing concern for the surgeon. Although the importance of early postoperative mobilization is emphasized to all patients, many patients, especially those from rural areas, have no access to specialized physiotherapy and do not understand the importance of the same. These patients also do not visit the hospital on scheduled days of follow-up due to various socio-economic reasons. Hence, such patients can have restrictions on knee movements (flexion as well as extension) very early during the postoperative period. We present our study protocol for early manipulation under general anesthesia (MUGA) and suture removal at 3 weeks after surgery for these fractures. At 3 weeks, the soft tissue healing of the trauma as well as the surgery have occurred to a great extent. The surgical site pain and inflammation have also reduced. All patients who are operated on will always come to hospital for suture removal. We planned to do a MUGA for the knee along with suture removal at 3 weeks for these patients. Materials and Methods: A prospective study was carried out at our institution for patients admitted and operated on for an intra-articular distal femur fracture. These patients were evaluated for knee range of motion at 3 weeks and posted for manipulation under anesthesia (MUA) and suture removal. Results: The 15 patients who were operated on for an intra-articular distal femur fracture underwent early MUA at 3 weeks. The mean pre-manipulation mean knee flexion was 60°. On manipulation, mean knee flexion of 110° was achieved. At the time of follow-up at 3 months, mean knee flexion was 123°. The average time for MUA was 15 min. No complications occurred during manipulation procedures. Conclusion: Early MUA is a suitable and effective noninvasive treatment modality for postoperative stiffness in cases of intra-articular distal femur fractures.