Distal Femur Supracondylar Fracture - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 17 มิ.ย. 2024
- Dr. Ebraheim’s educational animated video describes Supracondylar fracture of the distal femur.
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Supracondylar femur fractures can occur in young patients due to high energy trauma and when it occurs in older patients; it usually occurs due to low energy trauma such as a fall (osteoporotic bone). When you see a supracondylar fracture of the distal femur involving the joint, you need to achieve anatomic reduction of the joint, provide stable fixation for the fracture, and achieve the proper length, alignment, and rotation. We hope that the stable fixation will allow the patient to have early range of motion and this will help in cartilage repair. Supracondylar fracture of the femur is a complicated injury. The distal femur is usually shattered and the joint can be involved. The patient may have poor bone quality. There may be prosthesis or a previous fracture that may complicate management of this fracture. The fracture can be open in about 5%-10% of the patients and there is an increased incidence of nonunion and malunion with these fractures. Sometimes there will be a vascular injury. The patient may have decreased pulses compared to the other side. You should get the ankle brachial index (ABI) for the injured side. You may want to get CTA or arteriogram. In this situation, you may want to use an external fixator initially. From the joint to the metaphyseal/diaphyseal area is about 15 cm. The distal femur is trapezoidal in shape. The posterior portion is wider than the anterior portion. The medial aspect of the trochlear groove is lower. The medial side shows a 25 degree decrease in width from posterior to anterior. Hardware inserted from the lateral side may penetrate into the joint. Try to direct the screws away from the joint to avoid joint penetration. When placing screws across the condyles, the x-ray may appear as if the screws are within the bone, however the screws may be long and protruding medially, causing occult post-operative irritation and pain. The screw should end 1 cm short of the projected medial cortex. An internal rotation view of the distal femur will help you to see the prominent and long screws. The posterior half of both condyles lies posterior to the femoral shaft so the lateral axis of the femur is anterior. Coronal fracture of the posterior lateral condyle of the femur that could be missed. Suspect Hoffa fracture in comminuted fractures. You may see double density on an AP view. The fracture line can be seen on the lateral or the oblique view. CT scan will definitely show the fracture. This fracture may require different and separate fixation than the supracondylar plate fixation. The gastrocnemius muscle pulls the distal fracture fragment into recurvatum (extension). The hamstrings and the quadriceps cause shortening of the fracture. Nonoperative treatment is rare. It is used for nondisplaced fractures in patient with comorbidities and for non-ambulatory patients. Surgery will probably require preoperative planning. You may want to sue a plate or a rod in this situation (external fixator is rarely used). Retrograde femoral nailing is a minimally invasive surgical approach. It is ideal for ipsilateral femoral neck and shaft fractures when two devices are used. The rod should be inserted proximally to the level of the lesser trochanter. It is important to select proper location for insertion of the rod. The starting point is the center and intercondylar notch just superior to the Blumensaat’s line. You should check proper depth to avoid prominence in the joint, check the distal screws (may be long with medial prominence), and you may need internal rotation view for the diagnosis. Plating of the distal femur can be approached laterally, anterolaterally, or medially. In the lateral approach, the surgical approach is usually done laterally and minimally invasive. In the anterolateral approach, this will allow you to see the joint and reduce the intra-articular fracture under direct vision. The joint fragments must be reduced anatomically and the fixation has to be stable. In the medial approach, you may use anti-glide plate for medial condylar fracture of the distal femur. Fracture distal femur after total knee replacement (periprosthetic fracture) can be treated surgically. If the prosthesis is stable, then you will do fixation. You should do fixation with a plate or a rod (short rod or long rod) if the rod can be done through the femoral component or if the prosthesis is not stable then you will do revision of the prosthesis. The whole idea is limited incisions with exposure of the joint if necessary and no soft tissue stripping. The plating is usually done percutaneous or submuscular. It is called biological fixation or minimally invasive plate fixation. You will do direct reduction for the intra-articular fracture; however, for the metaphyseal diaphyseal fracture, you will do indirect reduction.
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Thank you for making this awesome video!!!
Thank you for the great job
Thank you so much for this educational video, very informative and helpful.
Ttytr
Thank you for information
May God bless u
Nice update sir.....thanks
Thanks .golden information .
Thanks for you sir
Very helpfull indeed.
Quite helpful. Thank you
it is helpful as always
❤❤❤❤
Hello
Sir
Please tell the name of this type of fracture.
Can it be treated non surgically?
I have Ten screws and a Plate for almost 2yrs now but they are temporary in two months time they will be removed. Exercise is very necessary,that is what has helped me greatly now I walk without limping difficulties I walk up and down the stairs, I can jog,squatt do my house chores almost do everything as I used to do
What did you do to heal its been 9mo for me still can't walk without walker and pain.?
@@cherylbales8371it depends on the kind of fructure also.BUT Always Exercises walking using crutches because I nine months now you need to have graduated from the walker to crutches. But also it is very necessary to seek advice from your physiotherapist. Wishing you all the Best my dear Cheryl
Hi are the plates removable?
🙌
Dear sir , my comunicated distal femur frature, surgery done on 4.4.2022.. 28 day i am on mobilation period, then i start knee bending prtice, but i cant my knee, so what i can do, pl suggest
Can you now bend cause I also can't bend the knee I have ex fix ...bplz tell me ur progress
@@chakgameskills5785 yes my knee bend is almost 110 degree
Locking plate
Mera bhi esa hi huha lekin 90° Leg Hold ho rha hey
Bhai mera bhi ese hi ho rha hai kya kre..?
Kitna din me full running kar sakte hai bhai 😭😭😭 please Reply
Kitna din me 90 degree huaa bhai
Right leg below knee amputed n femur broken plate puted sir six months back, problem is knee stiffed not bending anybody help me plz
Have same problem dear do proper physiotherapy then knee bend hope so my knee also maximum 30 degree bend yet
Im also having same issue but my knee also stiffed.
Not bending max of 30°
Physiotherapy is so painful and no use.
Did u recovered?
Hope u answer
Take an xray to see callous formation.
If xray is fine , start with vigorous physiotherapy
Start CPM from 30 degree and reach 90 degree by end of 1 month.
Also start quadriceps and hamstring strengthening exercise.
Hot fomenation.
Last 3 year i suffering 😭😭😭
Yes I am three years suffering
Sar i met this is my knee problem Sar please your detl adres and lokesan
همینو داشتم دکتر پامو داغون کرد
Thank you for the great job