Primary femoral shortening osteosynthesis in the management of comminuted supracondylar femoral fractures

Abstract

Supracondylar fractures are most often the result of high-energy vehicular trauma in the young population, and the result of low-energy injuries in the elderly. Therefore, these fractures are generally associated with comminution or osteoporosis. Anatomic reconstruction with stable medial buttressing is often not possible. Utilization of AO principles and techniques with anatomic reduction and internal fixation often fails to yield sufficient stability. We have developed a technique for the treatment of these distal femoral fractures which involves shortening by impaction. Rather than achieving anatomic reduction, the femur is shortened by telescoping the fragments to reestablish inherent stability of the bone prior to internal fixation. Over a 20-year period we treated 25 commnnuted supracondylar femoral fractures with primary shortening osteosynthesis in 24 patients. Sixteen patients were available for review at an average follow-up of 10 years (range 4–24 years). Ninety-four percent of the patients demonstrated complete radiographic consolidation by 14 weeks after the operative intervention. One patient required secondary bone grafting and reached consolidation at 30 weeks. Primary cancellous grafting was utilized in only 25% of the patients. One-third of the patients in review were given a heel lift; the average shortening in these patients was 2.6 cm (range 2.1–5 cm). Two-thirds of the patients did not require a heel lift, the average shortening in this group of patients being 1.2 cm (range 0.8–2.0 cm). At follow-up the average range of motion of the knee was 114° (range 90°–130°). All patients had full extension and an average loss of flexion compared to the contralateral knee of 16°. The functional results of these patients at follow-up were analyzed according to criteria established by Neer. A functional evaluation and radiographs were obtained in all these patients at follow-up and showed an excellent result in 44%, a good result in 38%, and a satisfactory result in 18%. Primary shortening osteosynthesis is a very predictable method of managing comminuted supracondylar fractures of the femur with good results.