G. Blatter et al., PRIMARY FEMORAL SHORTENING OSTEOSYNTHESIS IN THE MANAGEMENT OF COMMINUTED SUPRACONDYLAR FEMORAL FRACTURES, Archives of orthopaedic and trauma surgery, 113(3), 1994, pp. 134-137
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.