PRIMARY FEMORAL SHORTENING OSTEOSYNTHESIS IN THE MANAGEMENT OF COMMINUTED SUPRACONDYLAR FEMORAL FRACTURES

Supracondylar fractures are most often the result of high-energy vehic ular trauma in the young population, and the result of low-energy inju ries in the elderly. Therefore, these fractures are generally associat ed with comminution or osteoporosis. Anatomic reconstruction with stab le medial buttressing is often not possible. Utilization of AO princip les and techniques with anatomic reduction and internal fixation often fails to yield sufficient stability. We have developed a technique fo r the treatment of these distal femoral fractures which involves short ening by impaction. Rather than achieving anatomic reduction, the femu r is shortened by telescoping the fragments to reestablish inherent st ability of the bone prior to internal fixation. Over a 20-year period we treated 25 comminuted supracondylar femoral fractures with primary shortening osteosynthesis in 24 patients. Sixteen patients were availa ble for review at an average follow-up of 10 years (range 4-24 years). Ninety-four percent of the patients demonstrated complete radiographi c consolidation by 14 weeks after the operative intervention. One pati ent required secondary bone grafting and reached consolidation at 30 w eeks. Primary cancellous grafting was utilized in only 25% of the pati ents. One-third of the patients in review were given a heel lift; the average shortening in these patients was 2.6 cm (range 2.1-5 cm). Two- thirds of the patients did not require a heel lift, the average shorte ning in this group of patients being 1.2 cm (range 0.8-2.0 cm). At fol low-up the average range of motion of the knee was 114-degrees (range 90-degrees-130-degrees). All patients had full extension and an averag e loss of flexion compared to the contralateral knee of 16-degrees. Th e functional results of these patients at follow-up were analyzed acco rding to criteria established by Neer. A functional evaluation and rad iographs were obtained in all these patients at follow-up and showed a n excellent result in 44%, a good result in 38%, and a satisfactory re sult in 18%. Primary shortening osteosynthesis is a very predictable m ethod of managing comminuted supracondylar fractures of the femur with good results.