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DISTAL
FEMORAL FRACTURES
Supracondylar fractures occur just above the knee joint. The
distal fragment angulates posteriorly because of the pull
of the gastrocnemius muscle at its attachment on the posterior
aspect of the distal femur (Figure
18.49).
Intra-articular fractures occur as either a single femoral
condyle fracture (Figure 18.50) or as a supracondylar fracture
with extension distally into the joint (Figure
18.51).
Evaluation
There is a history of a high-energy injury and swelling and
deformity just above the knee. X-rays are necessary to confirm
the diagnosis and to evaluate articular surface injury. Carefully
check sensation, motor power and the vascular status of the
leg and foot.
Treatment
Non-displaced fractures
Treat non-displaced fractures in a long leg cast without weight
bearing.
Displaced fractures
| 1 |
Treat
displaced fractures in skeletal traction using a tibial
pin. Flexing the knee will help to reduce the angular
deformity of the distal femur. This is done with pillows
under the knee, balanced suspension or using Perkin’s
traction. |
| 2 |
Align
the articular surfaces to within a few millimetres using
traction, closed manipulation or open surgical reduction. |
| 3 |
Begin
quadraceps muscle strengthening in traction when pain
permits. |
| 4 |
When
the fracture is united (at 4–6 weeks), transfer
the patient to a long leg cast or cast brace with knee
hinges. |
| 5 |
Begin
weight bearing at 3 months when the fracture is solidly
healed. |
Popliteal artery injuries require immediate surgical correction
if the limb is to be saved.
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