Coronal Plane Small-Fragment Fixation in Supracondylar Intercondylar Femur Fractures

Supracondylar intercondylar distal femur fractures are devastating injuries that frequently have a concurrent coronal plane fracture, which mandates dedicated operative fixation. The purpose of this study was to determine whether small-fragment cortical lag screws oriented in the sagittal plane were sufficient to stabilize coronal plane fractures associated with supracondylar intercondylar distal femur fractures. The authors evaluated short-term radiographic outcomes in 56 coronal plane fractures in 44 knees (27 [61.4%] male, 17 [38.6%] female; mean age, 43 years [range, 19-97 years]) sustaining a supracondylar intercondylar distal femur fracture between January 2001 and November 2013. Coronal plane fractures were stabilized with sagittally oriented small-fragment cortical lag screws measuring 3.5 mm or smaller, and the supracondylar intercondylar component was stabilized with a lateral periarticular plate. Fracture displacement was defined as greater than 2 mm of gapping/translation of the coronal plane fragment on any radiographic view. Thirty-three (75.0%) knees had open injuries. Fifty-five (98.2%) of 56 coronal plane fractures went on to radiographic union with no displacement of the coronal fragment; one knee developed avascular necrosis and required arthrodesis. Fifteen (34.1%) of 44 knees required secondary procedures unrelated to the coronal plane fracture. The reduction of coronal plane fractures associated with supracondylar intercondylar distal femur fractures can be reliably maintained when stabilized with small-fragment cortical lag screws oriented in the sagittal plane.