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Supracondylar Femoral Fractures

- 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.

Alignment of supracondylar/intercondylar fractures of the femur after internal fixation by AO/ASIF technique.

The Treatment of Open Distal Femur Fractures With Immediate Open Reduction and Internal Fixation. Helpenstell T, et al. J Orthop Trauma. 1991;5:235.

Supracondylar fractures of the femur treated by external fixation

Treatment of Supracondylar Nonunions of the Femur with Plate Fixation and Bone Graft.  

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