Supracondylar Femoral Fractures : Wheeless' Textbook of Orthopaedics

- See:

       - Distal Femoral Shaft Fractures
       - Distal Femoral Phyeal Frx
       - Supracondylar Fractures following TKR

- Discussion:
    - work up for femur fracture
    - mechanism: axial load to a flexed knee;
- Bimodal distribution:
- low energy fractures involving older females (often have
                      severe osteoporosis);
- high energy fractures involving younger males;
- associated injuries:
- vascular Injury: 2-3% (similar to vessel injury in knee dislocations)
- knee ligament injuries: 20% (most commonly the ACL)
- tibial plateau fractures are also common;
- pertinent surgical anatomy

- Radiographs: (see: AO classification (Muller))
- must r/o a Hoffa extension (coronal plane fracture) in which case, a condylar buttress plate is required;
- tunnel view of the intercondylar notch is helpful in judging the displacement of vertical fractures into the jonit;
- in elderly patients who sustain low energy fractures it may be difficult to determine whether there is an intra-articular component;
- in these cases, consider obtaining a CT scan;

- Non Operative Therapy

- Operative Treatment: (discussion and surgical approach)
- open supracondylar frx
    - 95 deg. condylar blade plate
    - dynamic screw and side plate
    - condylar buttress plate
    - locking plate fixation: (see general concepts)
           - locking condylar plates (synthese menu)
           - pearls:
                  - pre-contoured plates are general under contoured compared to native femoral anatomy;
                  - often first screw is inserted proximally into the cortex so that proper proximal-distal plate position is obtained;
                  - if screw is tightened down all the way, under-contoured plate will cause fracture reduction distortion (medialization of frx);
                  - consider loosely applying this screw so that it maintains the plate position, but allows the distal locking screws to
                          properly engage the distal fragment;
                  - once the distal screws have been inserted, the original proximal screw can be fully tightened down, which should result
                          in an optimally reduced fracture;
                  - rotational alignment:
           - considerations for healing:
                  - non union may be as high as 20%;
                           - Non-union in lateral locked plating for distal femoral fractures: A systematic review.

                  - bone healing with plates
                  - fracture union is more likely when there are empty holes in the plate adjacent to fractures;
           - references:
                  - Additional fixation of medial plate over unstable lateral locked plating of distal femur fractures: A biomechanical study.
                  - Failure of LCP Condylar Plate Fixation in the Distal Part of the Femur. A Report of Six Cases.
                  - 2010 mid-America Orthopaedic Association Physician in Training Award: healing complications are common after locked plating for distal femur fractures.
                  - Dynamization of locked plating on distal femur fracture
                  - Open distal femur fractures treated with lateral locked implants: union, secondary bone grafting, and predictive parameters.
                  - Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study.
                  - Motion Predicts Clinical Callus Formation: Construct-Specific Finite Element Analysis of Supracondylar Femoral Fractures.
                  - Relationships between Hoffa fragment size and surgical approach selection: a cadaveric study

    - IM nails for supracondylar fractures:
- Internal fixation of supracondylar femoral fractures: comparative biomechanical performance of the 95-degree blade plate and two retrograde nails.
                   - these authors used a modified retrograde IM nail (blade inserts into nail), and noted better stability than seen with
                           standard blade plate except in torsion

- Post Op Care

Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation.

Double-plating of comminuted, unstable fractures of the distal part of the femur.

Supracondylar fracture of the femur following prosthetic knee arthroplasty.

Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur.

Surgical treatment of displaced, comminuted fractures of the distal end of the femur.

Rush-pin fixation of supracondylar and intercondylar fractures of the femur.

Fractures of the distal femoral epiphyses. Factors influencing prognosis: a review of thirty-four cases.

Physeal arrest about the knee associated with non-physeal fractures in the lower extremity.

Supracondylar fracture of the femur: closed or open reduction?

Supracondylar femoral fractures in the frail elderly. Fractures in need of treatment.