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Research Article| Volume 31, ISSUE 3, P139-146, April 2000

Treatment of isolated complex distal femoral fractures by external fixation

      Abstract

      Thirteen patients with isolated distal femoral fractures were treated by external fixation. There were seven males and six females with an average age of 45 years. Four were Type A3 fractures, one Type C1, five Type C2 and three Type C3 fractures. Seven of these were open. In seven cases the articular surface was first reduced and fixed. The fixation was extended across the knee to supplement the distal fixation in six severe cases. The average follow up was 30 months.
      There was one non-union in the study with the average time to union in the other patients being six months. Using the Mize criteria for assessing clinical results we found that nine patients obtained a good to excellent score and four were classed as failures. The average range of movement of the knee in the study was 100°. Apart from the single non-union all the fractures healed and there were no other serious complications.
      Considering the severity of the fractures we did not find any evidence to suggest that temporary fixation of the lateral soft tissues by fixator pins was detrimental. The results suggest that external fixation may be used to treat these difficult fractures without the risk of serious complications.
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      References

        • Johnson K.D.
        • Hicken G.
        Distal femoral fractures.
        Orthop. Clin. North Am. 1987; 18: 115-132
        • Neer C.
        • Brantham S.
        • Shelton M.
        Supracondylar fracture of the adult femur: a study of one hundred and ten cases.
        J. Bone Joint Surg. 1967; 49A: 591-613
        • Connolly J.F.
        • Dehne D.
        • La Follette B.
        Closed reduction and early cast brace ambulation in the treatment of femoral fractures. Results of one hundred and forty three fractures.
        J. Bone Joint Surg. 1973; 55A: 1581-1599
        • Healy W.L.
        • Brooker A.F.
        Distal femoral fracture: comparison of open and closed methods of treatment.
        Clin. Orthop. Relat. Res. 1983; 174: 166-171
        • Shelton M.L.
        • Grantham S.A.
        • Neer C.S.
        • Singh R.
        A new fixation device for supracondylar and low femoral shaft fractures.
        J. Trauma. 1974; 14: 821-835
        • Siliski J.M.
        • Mahring M.
        • Hofer H.P.
        Supracondylar intercondylar fractures of the femur.
        J. Bone Joint Surg. 1989; 71A: 95-104
        • Giles J.B.
        • DeLee J.C.
        • Heckman J.P.
        • Keever J.E.
        Supracondylar–intercondylar fractures of the femur treated with a supracondylar plate and lag screw.
        J. Bone Joint Surg. 1982; 64A: 864-870
        • Sanders R.
        • Regazzoni P.
        • Ruedi T.
        Treatment of supracondylar–intercondylar fractures of the femur using the dynamic condylar screw.
        J. Orthop. Trauma. 1989; 3: 214-222
        • Johnson K.D.
        Internal fixation of distal femoral fractures.
        Instructional Course Lecture. 1989; 38: 437-448
        • Sanders R.
        • Swiontkowski M.
        • Rosen H.
        • Helfet D.
        Double plating of comminuted unstable fractures of the distal part of the femur.
        J. Bone Joint Surg. 1991; 73A: 341
        • Leung K.S.
        • Shen W.Y.
        • So W.S.
        • et al.
        Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur.
        J. Bone Joint Surg. 1991; 73A: 332
        • Wu C.
        • Shih C.
        Interlocking nailing of distal femoral fractures.
        Acta Orthop. Scand. 1991; 62: 342-345
        • Wu C.
        • Shih C.
        Treatment of femoral supracondylar unstable supracondylar fractures.
        Arch. Orthop. Trauma. 1992; 111: 232-236
        • Iannacone W.M.
        • Bennett F.S.
        • De Long W.G.
        • et al.
        Initial experience with the treatment of supracondylar fractures using the supracondylar intramedullary nail: a preliminary report.
        J. Orthop. Trauma. 1994; 8: 322-327
        • Lucas S.E.
        • Seligson D.
        • Henry S.L.
        Intramedullary supracondylar nailing of femoral fractures. A preliminary report of the GSH supracondylar nail.
        Clin. Orthop. Relat. Res. 1993; 296: 200-206
        • Zickel R.E.
        • Hobeika P.
        • Robbins D.S.
        Zickel supracondylar nails for fracture of the distal end of the femur.
        Clin. Orthop. Relat. Res. 1986; 212: 79-88
        • Freedman E.L.
        • Hak D.J.
        • Johnson E.E.
        Total knee replacement including a modular distal femoral component in elderly patients with acute fracture or non-union.
        J. Orthop. Trauma. 1995; 9: 231-237
        • Wiss D.A.
        Rockwood Jr., C.A. Green D.P. Fractures in Adults. Lippincott-Raven, 1996: 1972-1999
        • Muller M.
        • Nazarian S.
        • Koch P.
        • Schatzker J.
        A Comprehensive Classification of Fractures of Long Bones. Springer-Verlag, Berlin1990: 138-147
        • 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. 1982; 64A: 871-879
        • Iannacone W.M.
        • Taffet R.
        • et al.
        Early exchange intramedullary nailing of distal femoral fractures with vascular injury initially stabalized with external fixation.
        J. Trauma. 1994; 37: 446-451
        • Ronen G.M.
        • Michaelson M.
        • Waisbrod K.
        External fixation in war injuries.
        Injury. 1974; 6: 94-98
        • Seligson D.
        • Kristainson T.K.
        Use of the Wagner apparatus in complicated fractures of the distal femur.
        J. Trauma. 1978; 18: 795-799
        • Van der Werken C.
        • Meeuwis J.D.
        • et al.
        Treatment of femoral fractures with the Ilizarov fixator (German).
        Unfallchirurg. 1992; 95: 534-536
        • Noer H.H.
        • Christenson N.
        Distal femoral fractures treated by external fixation with orthofix (Danish).
        Hgeskrift Laeger. 1993; 155: 2699-2702
        • Merchan E.
        • Maestu P.
        • Blanco R.
        Blade Plating of closed displaced supracondylar fractures of the distal femur with the AO system.
        J. Trauma. 1992; 32: 174-178
        • Danziger M.R.
        • Caucci D.
        • Zecher S.B.
        • et al.
        Treatment of intercondylar and supracondylar distal femoral fractures using the GSH supracondylar nail.
        Am. J. Orthop. 1995; 24: 684-690
        • Schatzker J.
        • Horne G.
        • Waddell J.
        The Toronto experience of the supracondylar fracture of the femur 1966–1972.
        Injury. 1974; 6: 113
        • Stewart M.J.
        • Sisk T.D.
        • Wallace Jr., S.L.
        Fracture of the distal third of the femur. A comparison of methods of treatment.
        J. Bone Joint Surg. 1966; 48A: 784-807
        • Kuntscher G.B.
        Practice of Intramedullary Nailing (translated). Charles C. Thomas, Springfield, IL1967: 234-258
        • Foster T.E.
        • Healy W.L.
        Operative management of distal femoral fractures.
        Orthop. Rev. 1991; 20: 962-969