Research Article| Volume 28, SUPPLEMENT 1, A31-A41, 1997

Transarticular joint reconstruction and indirect plate osteosynthesis for complex distal supracondylar femoral fractures

      This paper is only available as a PDF. To read, Please Download here.


      In a prospective study conducted between 1992 and 1995, displaced Müller type C2–C3 intraarticular fractures of the distal femur were treated using an indirect plate fixation technique and a lateral parapatellar arthrotomy for the direct reduction of the condylar block. There were 6 closed, and 2 open fractures (1 grade II and 1 grade IIIB). Following reconstruction of the articular block, the block was indirectly reduced and fixed to the shaft by a plate inserted by the retrograde method beneath the vastus lateralis. Transcutaneous/transmuscular screws were used to fix the plate to the shaft. Time to bone healing was 12 weeks (median range 8–17 weeks) after surgery without needing primary or secondary bone grafts. There were no infections or refractures. Except for one case which required a corrective osteotomy for 10° of varus malalignment, there were no revisions. According to the Neer score, there were 6 excellent or satisfactory results, 2 unsatisfactory results, and no failures. At follow-up, there were 2 varus-valgus deformities greater than 5°, 2 leg length discrepancies greater than 10 mm, and 2 rotational deformities of 15°.
      The treatment results for complex supracondylar/intracondylar fractures of the distal femur obtained with this technique compare favourably with other reported series using different techniques without the added morbidity associated with autogenous bone grafting. However, the surgical technique is demanding and special care must be taken to ensure correct axial alignment.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hall M.F.
        Two-plane fixation of acute supracondylar and intracondylar fractures of the femur.
        South Med. J. 1978; 71: 1474-1479
        • Chiron H.S.
        • Tremoulet J.
        • Casey P.
        • Muller M.
        Fractures of the distal third of the femur treated by internal fixation.
        Clin. Orthop. 1974; 100: 160-170
        • Giles J.B.
        • DeLee J.C.
        • Heckman J.D.
        • Keever J.E.
        Supracondylar-intercondylar fractures of the femur treated with a supracondylar plate and lag screw.
        J Bone Joint Surg. Am. 1982; 64: 864-870
        • Johnson K.D.
        Internal fixation of distal femoral fractures.
        Instr. Course Lect. 1987; 36: 437-448
        • Mize R.D.
        • Bucholz R.W.
        • Grogan D.P.
        Surgical treatment of displaced, comminuted fractures of the distal end of the femur.
        J Bone Joint Surg. Am. 1982; 64: 871-878
        • Olerud S.
        Operative treatment of supracondylarcondylar fractures of the femur.
        J Bone Joint Surg. Am. 1972; 54: 1015-1032
        • Pritchett J.W.
        Supracondylar fractures of the femur.
        Clin. Orthop. 1984; : 173-177
        • Sanders R.
        • Regazzoni P.
        • Ruedi T.P.
        Treatment of supracondylar-intracondylar fractures of the femur using the dynamic condylar screw.
        J. Orthop. Trauma. 1989; 3: 214-222
        • Schatzker J.
        • Lambert D.C.
        Supracondylar fractures of the femur.
        Clin. Orthop. 1979; 138: 77-83
        • Shelton M.L.
        • Grantham S.A.
        • Neer C.S.
        • Singh M.
        A new fixation device for supracondylar and low femoral shaft fractures.
        J. Trauma. 1974; 14: 821-835
        • Shewring D.J.
        • Meggitt B.F.
        Fractures of the distal femur treated with the AO dynamic condylar screw.
        J Bone Joint Surg. Br. 1992; 74: 122-125
        • Siliski J.M.
        • Mahring M.
        • Hofer H.P.
        Supracondylarintercondylar fractures of the femur. Treatment by internal fixation.
        J Bone Joint Surg. Am. 1989; 71: 95-104
        • Trentz O.
        • Tscherne H.
        • Oestern H.-J.
        Operationstechnik and Ergebnisse bei distalen Femurfrakturen.
        Unfallheilunde. 1977; 80: 441-448
        • Tscherne H.
        • Oestern H.J.
        • Trentz O.
        Spätergebnisse der distalen Femurfraktur and ihre besonderen Probleme.
        Zbl. Chir. 1977; 102: 897-904
        • van der Werken C.
        • Marti R.K.
        • Raaymakers E.L.
        Distal femoral fractures, results of operative treatment.
        Neth. J. Surg. 1981; 33: 230-236
        • Zehntner M.K.
        • Marchesi D.G.
        • Burch H.
        • Ganz R.
        Alignment of supracondylar/intercondylar fractures of the femur after internal fixation by AO/ASIF technique.
        J Orthop Trauma. 1992; 6: 318-326
        • Müller M.E.
        • Nazarian S.
        • Koch P.
        • Schatzker J.
        The comprehensive classification of fractures of long bones.
        Springer, Berlin Heidelberg New York1990
        • Healy W.L.
        • Brooker A.F.
        Distal femoral fractures. Comparison of open and closed methods of treatment.
        Clin. Orthop. 1983; : 166-171
        • Yang R.S.
        • Liu H.C.
        • Liu T.K.
        Supracondylar fractures of the femur.
        J. Trauma. 1990; 30: 315-319
        • Müller M.E.
        • Allgöwer M.
        • Schneider R.
        • Willenegger H.
        Manual of internal fixation. Springer, Berlin Heidelberg New York1991
        • Sanders R.
        • Swiontkowski M.F.
        • Rosen H.
        • Helfet D.
        Double plating of comminuted, unstable fractures of the distal part of the femur.
        J Bone Joint Surg. Am. 1991; 73: 341-346
        • Mast J.
        • Jakob R.
        • Ganz R.
        Planning and reduction technique in fracture surgery.
        Springer, Berlin Heidelberg New York1989
        • Kinast C.
        • Bolhofner B.R.
        • Mast J.W.
        • Ganz R.
        Subtrochanteric fractures of the femur.
        Clin. Orthop. 1989; 238: 122-130
        • Ostrum R.F.
        • Geel C.
        Indirect reduction and internal fixation of supracondylar femur fractures without bone graft.
        J. Orthop. Trauma. 1995; 9: 278-284
        • Krettek C.
        Komplextrauma des Kniegelenkes - Diagnostik, Management and Therapieprinzipien.
        in: Tscherne H. Zentraleuropäischer Unfallkongress Budapest, Handout D3. 1994: 1-5 (Budapest)
        • Krettek C.
        • Schandelmaier P.
        • Tscherne H.
        Distale Femurfrakturen: Transartikuläre Rekonstruktion, perkutane Plattenosteosynthese and Retrograde Nagelung.
        Unfallchirurg. 1996; 99: 2-10
        • Krettek C.
        • Tscherne H.
        Distal Femoral Fractures.
        in: Fu F.H. Harner C.D. Vince K.G. Knee surgery. Williams & Wilkins, Baltimore1994: 1027-1035
        • Gustilo R.B.
        • Anderson J.P.
        Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones.
        J Bone Joint Surg. Am. 1976; 58: 453-458
        • Gustilo R.B.
        • Mendoza R.M.
        • Williams D.N.
        Problems in the management of type III (severe) open fractures: A new classification of type III open fractures.
        J Trauma. 1984; 24: 742-746
      1. Krettek C, Schandelmaier P, Miclau T, Grün O and Tscherne H. Techniques for control of axes, rotation and length in minimally invasive osteosynthesis. Injury Supplement (submitted).

        • Neer C.S.
        • Grantham S.A.
        • Shelton M.L.
        Supracondylar fracture of the adult femur. A study of one hundred and ten cases.
        J Bone Joint Surg. Am. 1967; 49: 591-613
        • Tegner Y.
        • Lysholm J.
        Rating systems in the evaluation of knee ligament injuries.
        Clin. Orthop. 1985; 198: 43-49
        • Johnson E.E.
        Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur.
        Clin. Orthop. 1988; 231: 154-162
        • Gravel C.A.
        • Lee T.T.
        • Chapman M.W.
        Operative management of the supracondylar fracture of the femur: comparison of the anterolateral approach to other surgical approaches.
        in: J. Bone Joint Surg. Br. Proceedings. 77. 1995: 311
        • Farouk O.
        • Krettek C.
        • Miclau T.
        • Schandelmaier P.
        • Guy P.
        The topography of the perforators of the deep femoral artery: a cadaver injection study.
        in: Orthopaedic Trauma Association (OTA), Annual Meeting Boston. 1996: 133-134 (Abstractbook)
        • Farouk O.
        • Krettek C.
        • Miclau T.
        • Schandelmaier P.
        • Guy P.
        • Tscherne H.
        Minimally invasive plate osteosynthesis and vascularity: preliminary results of a cadaver injection study.
        Injury. 1997; 28: 7-12
        • Wenzel H.
        • Casey P.A.
        • Herbert P.
        • Belin J.
        Die operative Behandlung der distalen Femurfraktur.
        AO Bull. 1970;
        • Slätis P.
        • Ryöppy S.
        • Huittinen V.M.
        AOI osteosynthesis of fractures of the distal third of the femur.
        Acta Orthop. Scand. 1971; 42: 162-172
        • Schatzker J.
        • Horne G.
        • Waddell J.
        The Toronto experience with the supracondylar fracture of the femur, 1966-72.
        Injury. 1974; 6: 113-128
        • Shahcheraghi G.H.
        • Doroodchi H.R.
        Supracondylar fracture of the femur: Closed or open reduction?.
        J. Trauma. 1993; 34: 499-502
        • Hoppenfeld S.
        • deBoer P.
        Surgical exposures in orthopaedics.
        in: The anatomic approach. Lippincott, Philadelphia1984: 357-387