[Surgical treatment of distal femoral fractures using extra-medullary osteosynthesis]

Forty seven fractures of the distal femur treated by internal fixation using a supracondylar compression screw or blade plate were retrospectively evaluated regarding their radiological and functional results. Blade plates were used for all types of distal femoral fractures until 1992; their indications were subsequently restricted to simple supracondylar fractures whereas a compression screw was preferred for other types of fractures. Taking into account the condition of the patients before fracture, 85% good and very good results were achieved with both techniques. Malunions resulted in poor functional outcomes (50% good and very good results). Malunions were mainly observed in patients with complex fractures (90% of cases with malunion), which confirms the poor prognosis of comminuted fractures. Nonunions (65%) and infection (3%) resulted in poor functional results. The presence of a bony defect in the medial femoral cortex increases the risk of nonunion; bone grafting should be used in such cases. The recent use of a long femoro-femoral external distractor in a few patients has proved of value as it allowed to achieve accurate reduction and considerably eased fracture reduction and fixation.