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Supracondylar fractures of the femur treated by external fixation
J L Marsh1, H Jansen, H K Yoong
1Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Objective:
To determine the results and complications of treating supracondylar fractures of the femur with external fixation.
Design:
Retrospective follow-up from the time of injury (inception cohort) to an average of thirty-one (range thirteen to seventy-two) months after injury.
Setting:
Tertiary care university hospital.
Patients:
All thirteen adult patients with supracondylar femur fractures treated with the method described were included. There were seven closed and five open fractures and five vascular injuries that required repair. Fractures were chosen for this technique on an individual basis by the treating surgeon.
Interventions:
The femoral condyles were reduced percutaneously or via a medial arthrotomy and stabilized with 6.5-millimeter cannulated screws. Fixator pins were placed from lateral to medial in the condyles and in the shaft above the fracture. The monolateral fixator was applied laterally and stabilized the reduced condyles to the shaft. Initial grafts of bone were used in five fractures. External fixation time averaged 127 days.
Outcome Measures:
During treatment we determined the occurrence of complications at the pin sites and the fracture site, the time of healing, and the angular alignment at healing. At the latest follow-up we determined the range of motion of the knee, knee stability, a standardized knee score, and on radiographs the occurrence of arthrosis.
Results:
Twelve fractures healed primarily. One patient had a fracture site infection and required further treatment before healing. Knee flexion was restricted while in the fixator but rapidly recovered after frame removal. At follow-up (average thirty-one months), the range of knee flexion averaged 111 degrees (range sixty-five to 140). The Iowa Knee Score averaged 87 points (range 75-93 points). Four femurs healed with angular malalignments, shortening, or both. Twelve knees had no detectable arthrosis.
Conclusions:
We concluded that in select supracondylar femur fractures, monolateral external fixation is a satisfactory treatment alternative.