SUPRACONDYLAR FRACTURES OF THE FEMUR TREATED BY EXTERNAL FIXATION

Objective: To determine the results and complications of treating supr acondylar fractures of the femur with external fixation. Design: Retro spective follow-up from the time of injury (inception cohort) to an av erage of thirty-one (range thirteen to seventy-two) months after injur y. Setting: Tertiary care university hospital. Patients: All thirteen adult patients with supracondylar femur fractures treated with the met hod described were included. There were seven closed and five open fra ctures and five vascular injuries that required repair. Fractures were chosen for this technique on an individual basis by the treating surg eon. Interventions: The femoral condyles were reduced percutaneously o r via a medial arthrotomy and stabilized with 6.5-millimeter cannulate d screws. Fixator pins were placed from lateral to medial in the condy les and in the shaft above the fracture. The monolateral fixator was a pplied laterally and stabilized the reduced condyles to the shaft. Ini tial grafts of bone were used in five fractures. External fixation tim e 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 la test follow-up we determined the range of motion of the knee, knee sta bility, a standardized knee score, and on radiographs the occurrence o f arthrosis. Results: Twelve fractures healed primarily. One patient h ad a fracture site infection and required further treatment before hea ling. Knee flexion was restricted while in the fixator but rapidly rec overed after frame removal. At follow-up (average thirty-one months), the range of knee flexion averaged 111 degrees (range sixty-five to 14 0). 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 s elect supracondylar femur fractures, monolateral external fixation is a satisfactory treatment alternative.