TRANSARTICULAR JOINT RECONSTRUCTION AND INDIRECT PLATE OSTEOSYNTHESISFOR COMPLEX DISTAL SUPRACONDYLAR FEMORAL FRACTURES

In a prospective study conducted between 1992 and 1995, displaced Mull er type C2-C3 intraarticular fractures of the distal femur were treate d using an indirect plate fixation technique and a lateral parapatella r arthrotomy for the direct reduction of the condylar block. There wer e 6 closed, and 2 open fractures (1 grade II and 1 grade IIIB). Follow ing reconstruction of the articular block, the block was indirectly re duced and fixed to the shaft by a plate inserted by the retrograde met hod beneath the vastus lateralis. Transcutaneous/transmuscular screws were used to fix the plate to the shaft. Time to bone healing was 12 w eeks (median range 8-17 weeks) after surgery without needing primary o r secondary bone grafts. There were no infections or refractures. Exce pt for one case which required a corrective osteotomy for 10 degrees o f varus malalignment, there were no revisions. According to the Neer s core, there were 6 excellent or satisfactory results, 2 unsatisfactory results, and no failures. At follow-up, there were 2 varus-valgus def ormities greater than 5 degrees, 2 leg length discrepancies greater th an 10 mm, and 2 rotational deformities of 15 degrees. The treatment re sults for complex supracondylar/intracondylar fractures of the distal femur obtained with this technique compare favourably with other repor ted series using different techniques without the added morbidity asso ciated with autogenous bone grafting. However, the surgical technique is demanding and special care must be taken to ensure correct axial al ignment.