The intra-articular supracondylar fractures of the femur are difficult fractures that occur with increasing frequency in the last years. Their complex management is a source of controversy, since surgical outcome is not acceptable in all instances. In the last 6 years we treated 30 comminuted intra-articular supracondylar fractures of the femur (type-C). The mean age was 28 years (17– 65 years). We made any effort to apply a method which could guarantee reduction and articular reconstruction, rigid fixation and bridging of metaphysic-epiphysis, in order to achieve early mobilization and to avoid post-traumatic osteoarthritic lesions. The extra-articular portion of the fractures was fixed using DCS, condylar plates, Ô plates and in some cases the whole construct was protected by an external fixation device. In some other cases, stability was enhanced using a second bridging plate in the medial side or applying a massive cortical graft properly adapted and fixed to the plate. The articular surface was reconstructed using cancellous lag-screws. Intra-articular epiphyseal portions were regularly bone grafted when there was comminution and bone loss, Bone grafting was also carried out in cases of meta-diaphyseal severe comminution and major bone defects. Clinical and radiological outcome was evaluated. Radiological parameters (axial valgus deformity, shortening, development of post-traumatic osteoarthritis etc.) were correlated to the method of surgical treatment. There were major complications (such as infection, especially in open fractures, delayed healing, hardware failure, refracture etc.). In some instances re-operation was necessary. In problematic C3 supracondylar fractures of the knee, poor surgical results are associated to early complications and development of degenerative lesions. This handicap is particularly is particularly important since it occurs in a major weight bearing joint of young patients. Using meticulous surgical technique (including bone-grafting, minimal devitalization of the fragments etc.), and choosing the most appropriate implant in every case, reconstruction can be performed reliably with good results and a low rate of complications.
