Abstract
Introduction A review of the the treatment of supracondylar fractures of the distal femur is presented.
Methods The material presented consists of a review of published literature and personal experience.
Results The introduction of the Condylar Blade Plate by the AO in the 1960s revolutionized the treatment of this injury. Numerous publications over the last 30 years attest to the superiority of the modern AO methods. The Comprehensive Classification of the supracondylar fractures greatly helps surgeons in decision making. The mid-line medial parapatelar surgical approach is preferred to the classical lateral incision. A lateral parapatellar incision has been in use recently in conjunction with the LISS and CLCP. A detailed understanding of the surgical anatomy of the distal femur prevents technical misadventures in securing stable fixation. Atraumatic reduction techniques have been developed to prevent devitalization of intermediate fragments which permits bridge plating and obviates the need of bone grafting multifragmentary fractures. Previously, failure to bone graft multifragmentary fractures was the commonest cause of failure of fixation. Current fixation devices are the classic condylar plate, the dynamic condylar screw, the condylar buttress plate, and the retrograde supracondylar femoral nail and the most recently developed LISS and the condylar locked compression plate. The choice of implant depends on the specific fracture pattern and associated soft tissue injury, concomitant apendicular and system injuries, the patient’s age and the presence of osteoporosis. The open supracondylar fracture presents unique problems which require careful judgement and staging in reconstruction. Even if they become infected, with proper stabilization 80% will still achieve satisfactory results. The supracondylar fracture in the presence of a total knee replacement is an absolute indication to surgical stabilization. It and osteoporosis present specific challenges which require specialized techniques of fixation for successful resolution. Polytrauma with multisystem injuries and certain specific concomitant articular injuries such as patellar fractures or fractures of the tibial plateau prejudice the outcome of treatment.
Conclusions With modern surgical treatment, young patients with isolated Type A, Type B and C1 or C2 fractures can expect a normal knee as the outcome of treatment. Type C3 fractures and open fractures continue to be a challenge and their outcome depends on the degree of initial articular cartilage destruction, the degree of bone fragmentation and displacement, and on the degree of soft tissue damage. Articular cartilage injury and severe osteoporosis continue to be the two most important unsolved problems in fracture surgery.
The abstracts were prepared by Mr Jerzy Sikorski. Correspondence should be addressed to him at the Australian Orthopaedic Association, Ground Floor, William Bland Centre, 229 Macquarie Street, Sydney NSW 2000, Australia.
None of the authors have received any payment or consideration from any source for the conduct of this study.
