Supracondylar femoral fractures

Dave Hak

V1
Juni 4, 2004

Supracondylar femoral fractures

 Supracondylar femoral fractures

Supracondylar femur fractures

1. Title slide

2. Objectives of lecture

3. There are two distinct populations – young adults with high

energy trauma – elderly patients with low energy falls

4. Strong muscular forces created displacement of the fracture

making non operative treatment problematic

5. AO classification of distal femoral fractures

6. The 33B3 Hoffa fracture, which is a coronal split, splitting off

the posterior femoral condyle requires fixation with AP lag
screws. The presence of this fracture is therefore a contra-
indication to the use of either a DCS or a blade plate

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 Supracondylar femoral fractures

7. The presence of a Hoffa fracture can be identified on the

lateral X-ray by tracing out the arcs of both condyles

8. In severely comminuted fractures, a traction film helps

evaluate the fracture

9. Reconstruction of the distal femur must ensure that the

correct mechanical axis of the lower limb is restored

10. A line connecting the centre of the femoral head and the
centre of the talus should pass through the centre of the
knee – this is the mechanical axis. The knee joint axis is
roughly 90º to the mechanical axis

11. The mechanical axis and the anatomic axis are different with
a physiological valgus of between 7º and 9º at the knee joint

12. The distal femur has a trapezoidal shape. Screws inserted in

the anterior part of the femur will therefore appear to be too
short on a conventional AP X-ray

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 Supracondylar femoral fractures

13. The lateral femoral cortex slopes 10º

14. Because the lateral femoral cortex slopes 10º and the
implant sits on that cortex, a degree of internal rotation of
the implant is needed

15. The medial femoral cortex slopes 25º

16. The presence of the patella sulcus dictates the position of

lateral to medial lag screws

17. The presence of the inter-condylar notch marks the posterior

limit of implants applied transversely across the distal femur

18. An image intensifier will always give the impression that

screws correctly inserted in the anterior half of the femur
will be too short

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 Supracondylar femoral fractures

19. If the DCS is inserted in the centre of the femoral condyles,

the condyles will be mal-reduced anteriorally on the shaft,
creating medial translation and a varus deformity

20. If the DCS is inserted in the centre of the femoral condyles,

the condyles will be mal-reduced anteriorally on the shaft,
creating medial translation and a varus deformity

21. Choice of implants

22. The disadvantage of a lateral buttress plate is that is requires

medial support. Condylar plates applied to the lateral
surface therefore frequently fail into varus

23. Varus collapse can be minimised by the use of a fixed angle

device

24. Advantages and disadvantages of the retro-grade IM nail

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 Supracondylar femoral fractures

25. The ideal indication for a retrograde IM nail is a peri-

prosthetic fracture above a total knee replacement. (note
that not all total knee replacements have an open notch and
for these implants an IM nail is contra-indicated)

26. Advantages and disadvantages of the blade plate

27. Advantages and disadvantages of the DCS

28. Advantages and disadvantages of the L.I.S.S. plate

29. Screws inserted through the distal part of the L.I.S.S. are
convergent

30. The convergent distal screws give a very strong pull out
strength

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 Supracondylar femoral fractures

31. AP and lateral radiograph of a supra-condylar fracture with a

simple fracture pattern on the joint surface and severe
metaphyseal comminution

32. Fixation with L.I.S.S. plate

33. Operative goals of fixation

34. High velocity injuries are always associated with significant

soft tissue damage. Use of a temporary ex-fix to allow
recovery of the soft tissues maybe advisable in these injuries

35. Postero-lateral approach to distal femur

36. Lateral para-patella approach to expose the articular surface

of the distal femur

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 Supracondylar femoral fractures

37. What ever surgical approach used must minimise soft tissue
stripping

38. The results of treatment are directly related to the

preservation of blood supply

39. The first stage of operative treatment is the anatomical

reduction and fixation of the joint surface

40. The position of the DCS wire or the blade plate is

determined by the anatomy of the distal femur

41. Correct entry point for DHS/blade plate

42. Dangers of an incorrect entry point

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 Supracondylar femoral fractures

43. Complications of operative treatment

44. Summary

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