Authors

Leung KS. Shen WY. So WS. Mui LT. Grosse A.

Title
Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the
femur.
Source
Journal of Bone & Joint Surgery - American Volume. 73(3):332-40, 1991 Mar.
Abstract
Thirty-seven fractures of the distal part of the femur in thirty-five patients were treated with interlocking
intramedullary nailing. All fractures were nailed by a closed technique after any intercondylar extension
of the fracture had been managed by reduction and stabilization with percutaneous lag-screws. Patients
who had an isolated condylar fracture or a severely comminuted intercondylar fracture were treated with
other types of implants. There were thirty extra-articular (type-A) fractures and seven intra-articular
(type-C1 and type-C2) fractures. Postoperatively, early mobilization exercises and weight-bearing were
begun. At an average duration of follow-up of 20.5 months (range, fifteen to twenty-six months), all
thirty-seven fractures had healed. There were no malunions of either the supracondylar or the
intercondylar fractures. Complications were infrequent and included chronic irritation from the distal
screws in three patients and delayed union in one; the latter healed with two centimeters of shortening
after bone-grafting. There were no infections. The functional results were assessed with the modified
knee-rating system of The Hospital for Special Surgery. Thirteen knees (35 per cent) had an excellent
result; twenty-two (59 per cent), a good result; and two (5 per cent), a fair result. The results correlated
with the age of the patient and the presence of an intra-articular fracture. We concluded that closed
interlocking intramedullary nailing is an excellent technique for both supracondylar and simple
intercondylar fractures in which closed reduction and percutaneous fixation of the articular fracture is
possible.
Authors
Siliski JM. Mahring M. Hofer HP.
Title
Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation.
Source
Journal of Bone & Joint Surgery - American Volume. 71(1):95-104, 1989 Jan.
Abstract
The records on fifty-two supracondylar-intercondylar fractures of the femur were reviewed twenty to 120
months after injury. More than one-third of the fractures had been open. All of the fractures were treated
in a single trauma center, using: (1) a single lateral incision, (2) internal fixation with ASIF
interfragmentary screws and plates, (3) bone-grafting of comminuted metaphyseal segments, (4)
impaction of comminuted metaphyseal segments in osteoporotic elderly patients, and (5) repair of any
associated torn ligaments and patellar fractures. Postoperatively, early active motion of the knee was
encouraged, and for selected patients a brace was used only to protect the repair of associated disruptions
of ligaments or of the extensor mechanism. The fractures were classified by the ASIF system, with C1
being a simple Y pattern, C2 having additional supracondylar comminution, and C3 having intra-articular
comminution. The final results were rated using the system that was described by Neer et al. for fractures
of the distal end of the femur. The average time between the operation and full weight-bearing (healing)
was 13.6 weeks and ranged from 12.3 weeks for C1 fractures (as graded using the ASIF classification) to
15.4 weeks for C3 fractures. The average final arc of motion of the knee was 107 degrees, ranging from
113 degrees for C1 fractures to 99 degrees for C3 fractures. C1 fractures had a better outcome (92 per

cent excellent and good results) than did C2 and C3 fractures (77 per cent excellent and good results).
Two amputations and one arthrodesis were done to treat infection, and infection accounted for three of the
four poor results. Age did not influence the final results, although elderly patients had a longer period of
hospitalization. Supracondylar-intercondylar fractures of the femur should be analyzed separately from
other fractures of the distal end of the femur because of their intra-articular involvement and associated
ligamentous injuries and patellar fractures. Rigid internal fixation permits early functional rehabilitation
of the patient and decreases the incidence of malunion, non-union, and loss of fixation.