- See:
-
Distal Femoral Shaft Fractures:
-
Distal Femoral Phyeal Frx:
-
Supracondylar Fractures following TKR:
- Discussion:
-
mechanism: axial load to a flexed knee;
- Bimodal distribution:
- low energy fractures involving older females (often these patients 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 condylar plates (synthese menu)
- ref:
Failure of LCP Condylar Plate Fixation in the Distal Part of the Femur. A Report of Six Cases.
-
IM nails for supracondylar fractures:
- Internal fixation of supracondylar femoral fractures: Comparative biomechanical performance of the 95 deg blade plate and two retrograde nails.
K Ito et al. J. Orthop Trauma. Vol 12. No 4. p 259-266. 1998.
- 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.
Supracondylar fracture of the femur after total 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.
Alignment of Supracondylar / Intercondylar Fractures of Femur After Internal Fixation by AO/ASIF Technique. J. Orthop. Trauma. Vol 6. No 3. pp 318-326.
The Treatment of Open Distal Femur Fractures With Immediate Open Reduction and Internal Fixation. T Helpenstell, ST Hansen Jr. J. Orthop. Trauma, 5: 235, 1991.
Supracondylar fractures of the femur treated by external fixation. JL Marsh, H. Jansen, HK Yoong, and EM Found. J. Orthop Trauma. Vol 11. No 6. p 405-411.
Treatment of Supracondylar Nonunions of the Femur with Plate Fixation and Bone Graft. MW Chapman MD. JBJS Vol 81-A. Sep 1999. p 1217.
