Abstract
Supracondylar femoral fractures challenge even the most experienced trauma surgeon. Fracture comminution often extends into the articular surface, increasing the risk of joint stiffness and post-traumatic arthritis. This is a preliminary prospective report of 42 supracondylar femoral nailing procedures performed on 41 patients between July 2000 and March 2001.
The mean age of the 21 women and 20 men was 62 years. Five fractures were compound. Classified according to AO classification, there were 28 type-AIII fractures, 10 type-AII, two type-CIII and two type-CII. In all cases a percutaneous surgical technique was used and a 13-mm x 250-mm supracondylar nail inserted. The mean operative time was 70 minutes. Mean follow-up was four months (2 to 10). There were no deep or superficial infections and no implant failures. Twenty fractures healed with no shortening within four months. The mean flexion arc was 105° (5° to 130°). Eight patients with osteoporosis had 1 cm to 2 cm of shortening, which did not affect functional outcome. Of the 20 patients whose fractures united, 17 had no pain and three had mild anterior knee pain. A single patient had 8° of valgus angulation at the fracture site.
This study shows that supracondylar femoral nailing provides improved fracture stabilisation both in elderly patients with osteoporotic metaphyseal bone and in younger patients with extensively comminuted fractures. Percutaneous techniques eliminate the need for extensive surgical dissection, shorten operation times and reduce blood loss.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
