Manejo de las fracturas supracondileas del fémur: experiencia del Hospital Dr. Miguel Pérez Carreño / Management of supracondylar femoral fractures: experience of Hospital Dr. Miguel Pérez Carreño

Las fracturas del extremo distal de fémur constituyen un grupo de lesiones de difícil manejo, cuyos resultados no son uniformemente buenos y cuyo tratamiento y recuperación requiere un considerable esfuerzo por parte del traumatólogo y del paciente. Su tratamiento a sufrido modificaciones considerables. El objetivo de este trabajo es describir la experiencia de nuestro centro en el manejo de las fracturas supracondileas de fémur. Se revisaron 76 historias con diagnostico de fractura supracondilea de fémur en el Hospital Central del IVSS “Dr. Miguel Pérez Carreño”, en el periodo comprendido de 2004 a 2008; de los cuales 87% son masculinos y 13% femenino, en una edad comprendida entre 10 a 76 años con una promedio de 35 años, el mecanismo de lesión mas frecuente fue heridas por arma de fuego con 37 casos (49%), las fracturas abiertas correspondieron a las tipo III A (69%). En 36 casos se observó un trazo de fractura metafisiario a causa de heridas por arma de fuego, con 47 días de hospitalización en promedio. El 58% de los pacientes recibió tratamiento quirúrgico, entre ellos DCS (48%), clavos endomedulares bloqueados (14%), placas anatómicas dístales de fémur (11%) y tutores en 4 casos, los clavos bloqueados retrógrados se colocaron a 3 pacientes. El 42% recibieron tratamiento conservador con yeso inguinopédico. Como complicaciones se reportaron pseudoartrosis en el 7%; rigidez articular 9% asociado con tornillos canulados, consolidación viciosa en un 25% y acortamiento de 5 cm en promedio de 13% (4 casos) asociado a tratamiento conservador. En cualquier caso el tipo de tratamiento, sea conservador o quirúrgico, requiere una previa valoración cuidadosa de la anatomía de la fractura y de la situación global del paciente.

Fractures of the distal femur are a group of injuries are difficult to manage, the results are not uniformly good and which treatment and recovery requires a considerable effort by the orthopedist and the patient. His treatment has undergone significant changes. The aim of this study is to describe our experience in the management of supracondylar fractures of the femur. 76 stories were revised diagnosis of supracondylar fracture of femur in the Central Hospital “Dr. Miguel Perez Carreño” IVSS in the period from 2004 to 2008, of whom 87% are male and 13% female, at an age between 10 to 76 years with an average of 35 years, the most frequent mechanism of injury was gunshot wounds in 37 cases (49%), open fractures corresponded to type III (69%). In 36 cases showed a metaphyseal fracture line due to gunshot wounds, with 47 days of hospitalization on average. 58% of the patients received surgical treatment, including DCS (48%), locked intramedullary nails (14%), distal femur anatomical plates (11%) and mentors in 4 cases, blocked retrograde nails were placed in 3 patients . 42% received conservative treatment with plaster inguinopédico. Complications included nonunion reported in 7% 9% joint stiffness associated with cannulated screws, malunion in 25% and shortening of 5 cm on average 13% (4 cases) associated with conservative treatment. In any case the type of treatment, whether conservative or surgical, requires prior careful assessment of the anatomy of the fracture and the overall situation of the patient.

Treatment of Periprosthetic Supracondylar Femur Fractures following Total Knee Arthroplasty: Minimally Invasive Technique using Locking Condylar Plate

PURPOSE: To evaluate clinical and radiological outcomes related to minimally invasive treatment of supracondylar periprosthetic fractures with locked condylar plates following total knee arthroplasty. MATERIALS AND METHODS: We studied 7 cases of periprosthetic supracondylar femoral fractures treated between January 2001 and June 2006. The mean patient age was 66 years (range: 62~72 years). The mean follow-up duration was 21 months (range: 12~41 months). The index operation implant was a posterior cruciate substitution implant without a stem. According to the Orthopedic Trauma Association (OTA) classification, all cases were 33A. RESULTS: Each case was treated using a locking condylar plate. The fracture was extended to the undersurface of the anterior flange of the femoral component. The locking condylar plate was fixed by minimally invasive percutaneous technique. The average time to bone union was 5 months (range: 3~6 months) without additional bone grafting. The mean range of motion was 96 degrees, and the mean Hospital for Special Surgery (HSS) score was 75 points at last follow-up. The mean femorotibial angle at last follow-up was valgus 5 degrees. CONCLUSION: Minimally invasive percutaneous fixation using a locking condylar plate was a useful alternative to a retrograde femoral nail in repairing periprosthetic femoral fractures

Therapy of fracture of femoral intercondylar and supracondylar by saddle-shaped condylar plate / 中国矫形外科杂志

[Objective]To investigate the clinical effect of saddle-shaped condylar plate in treating the fracture of the femoral intercondylar and supracondylar.[Method]Thirty-two cases with the fracture of the femoral intercondylar and sapracondylar,who were selected randomly were fixed by saddle-shaped condylar plates after reduction,of which 8 cases of patellar fractures accompanied with ipsilateral fracture of the femoral condylar.[Result]All cases were completely healed during the follow-up study of 4 months to 2 years,all cases achieved bone union in 5～9 months.[Conclusion]The design of the plate conforms to the principle of biomechanics and is good for the heal of the fracture.The saddle-shaped structure makes the plate and the cannular bone tangent as fixing so it can reduce the putrescence of the bone which is caused by pressure;The arch-bridge-shaped juncture and the mechanical bolts which are fixed across can strengthen the power of anti-bending and anti-rotation of the broken ends of the fractured bone.The stability of the fixation enables the patient do the functional exercise after the operation as soon as possible.It has definite clinical value and is worth of popularization.

Characteristics and Treatment Comparison of Military Training Injury Caused by Distal Femoral Fractures / 医疗卫生装备

Objective To analyze the characteristics of military training injury caused by distal femoral fractures that used reverse interlocking intramedullary nail(retrograte nails) and condylar plate to fix,and then compare the clinical treatment effects.Methods Retrospective analysis of clinical information of 30 cases,14 cases were treated with reverse interlocking intramedullary nail(reverse nail group) and 16 cases with condyle plate fixation(condyle plate group),all the cases were followed up for 12～20 months to compare the treatment effect and complications.Results According to Merchan criteria with clinical evaluation of knee function,the rate of good and excellent was 85.7% in the reverse interlocking in-tramedullary nail group,68.7%(P