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Supracondylar Fractures Of The Femur

Dr. Jamal Al -Saidy M.B.Ch.B. .F.I.C.M.S

 Supracondylar fractures of the femur are encountered :

(a) in young adults, usually as a result of high energy trauma
(b) in elderly, osteoporotic individuals .
 Dire ct violence is the usual cause.
 The fracture line is just above the condyles (Last 10 – 15 cm of femur )
but may extend between them .
 In the worst cases the fracture is severely comminuted
 A useful classification is from the AO group: -
a. Type A fractures have no articular splits and are truly supracondylar (Extraarticlar) .
b. Type B fractures are simply shear fractures of one of the condyles (Intraarticular unicondylar ).
c. Type C fractures have supracondylar and intercondylar fissures (Intraarticular bicondylar )
 Gastrocnemius, arising from the posterior surface of the distal femur, will tend to
pull the distal segment into extension and tilt the # posterior , thus risking injury
to the popliteal artery or compression of poplite al vessels & tibial nerve .
 # may be T - or Y -shaped
 # may be in the coronal plane (Hoffa #)

Type A Type B Type C

The AO classification of supracondylar fractures
(a) Type A fractures do not involve the joint surface
(b) type B fractures involve the joint surface (one condyle) but leave the
supracondylar region intact
(c) type C fractures have supracon dylar and condylar components.

Clinical features

 The knee is swollen because of a haemarthrosis – this can be severe en ough to
cause blistering later.
 Movement is too painful to be at tempted.
 The tibial pulses should always be checked to ensure the popliteal artery was not
injured in the fracture.
 X-RAY :- The entire femur should be x -rayed so as not to miss a proximal
fracture or dislocated hip.
Treatment
Non -operative :-
o If the fracture is only slightly displaced and extra -articular, or if it reduces
easily with the knee in flexion, it can be treated quite satisfactorily by traction
through the proximal tibia; the limb is cradled on a Thomas ’ splint with a
knee flexion piece and movements are encouraged. when the fracture is
beginning to unite, traction can be replaced by a cast and the patient allowed
up and partial ly weightbearing with crutches.
o Nonoperative treatment should be considered as an option if the patient is
young or the facilities and skill to treat by internal fixation are absent.
Operative :-
o Surgical treatment with internal fixation can enable accurate fracture
reduction, especially of the joint surface, and early movement.
o If the necessary facilities and skill are available, this is the treatment of
choice.
o For the elderly, early mobilization is so important that internal fixation is
almost obligatory.
o Several different devices are available: -
1. Locked intramedullary nails.
2. Plates that are applied to the lateral surface of the femur : traditional
angled blade -plates or 95 degree condylar screw - plates.
3. Simple lag screws .
o Knee movements are started soon after operation, if wound healing allows.
This limits adhesions forming within the knee joint.

Complications

EARLY
o Arterial damage :- There is a small but definite risk of arterial damage and
distal ischaemia. Careful assessment of the leg and peripheral pulses is
essential, even if the x -ray shows only minimal displacement.
LATE
o Joint stiffness :- Knee stiffness – probably due to scarring from the injury and
the operation – is almost inevitable. A long period of exercise is needed in all
cases, and even then full movement is rarely regained. For marked stiffness,
arthroscopic division of adhesions in the joint or even a quadricepsplasty may
be needed.
o Malunion :- Internal fixation of these fractures is difficult and malunion –
usually genu varus , valgus and recurvatum – is not uncommon. Corrective
osteotomy may be needed for patients who are still physically active.
o Non -union :- If non -union does occur, autogenous bone grafts and a revision
of internal fix ation will be needed .
o OA of the knee.

Fracture -Separation Of Distal Femoral Epiphysis

 In the childhood or adolescent equivalent of a supracondylar fracture,
 the lower femoral epiphysis may be displaced – either to one side (usually
laterally) by forced angulation of the straight knee or forwards by a
hyperextension injury.
 This injury is important because of its potential for causing abnormal growth
and deformit y of the knee.
 The fracture is usually a Salter –Harris type 2 lesion – i.e. physeal separation
with a large triangular metaphyseal bone fragment.
 This type of fracture usually has a good prognosis, asymmetrical growth
arrest is not uncommon and the child m ay end up wi th a valgus or varus
deformity.
 The fracture can usually be perfectly reduced manually, but further x -ray
checks will be needed over the next few weeks to ensure that reduction is
maintained.
 Occasionally open reduction is needed; a flap of periosteum may be trapped
in the fracture line. Salter – Harris types 3 and 4 should be accurately reduced
and fixed.
THANK YOU Dr. Jamal Al -Saidy M.B.Ch.B. .F.I.C.M.S


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