INDIRECT REDUCTION AND INTERNAL-FIXATION OF SUPRACONDYLAR FEMUR FRACTURES WITHOUT BONE-GRAFT

Thirty supracondylar-intercondylar fractures of the distal femur were treated in a prospective series using an indirect reduction technique. From January 1988 to July 1993, patients who entered into this protoc ol had undergone fixation with a distal lateral plate without strippin g of the medial soft tissues and without bone graft. With this techniq ue, 86.6% excellent and satisfactory results were achieved using the N eer rating system. Of the three failures, two were in elderly, osteopo rotic women with comminuted intraarticular fractures, and one failure occurred in a renal transplant patient with bilateral quadriceps ruptu res despite a good result from her femur fracture. Only one patient wi th a grade 2 open fracture and comminution developed a nonunion, which eventually healed after bone grafting. The results of this technique compare favorably with other series of osteosynthesis of supracondylar femur fractures in the orthopaedic literature without the added morbi dity associated with autogenous bone grafting. The surgical technique is demanding and may not be suitable for patients with severe open fra ctures with devascularized bony fragments or marked osteoporosis.