Supracondylar Femur Fracture: Rod

David Seligson, Ivan Federico Rubel

Supracondylar femoral fractures have been classified as type A, extraarticular fractures; type B, unicondylar fractures; and type C, intraarticular fractures.¹

Of the various techniques available for fixation of the distal femur, the intramedullary supracondylar nail is a simple solution.

Indications

Type A and C supracondylar femoral fractures (Fig. 30–1)^2–5
Fractures proximal to a knee prosthesis or distal to hip implants
Obesity, injury at the trochanteric entrance point, or for positioning problems

Contraindications

Type B or transcondylar fractures involving the distal 2 to 3 cm of the femur
Preexisting intramedullary implant in the distal femoral canal

Physical Examination

Knee effusion, ecchymosis, soft tissue damage, pain, tenderness and swelling; also length, axial, or rotational deformity centered in the supracondylar region

Diagnostic Tests

History and physical exam, complete blood count, urinalysis, prothrombin time, type, and screen; anteroposterior (AP) and lateral views of the distal femur and knee
Computed tomography scan if fracture pattern is complex

Special Considerations

Open reduction may be indicated for type C fractures and

requires more time and equipment.

Preoperative Planning and Timing of Surgery

The procedure is delayed until the patient’s general and local problems allow surgery.
Ten- to 20-lb skeletal traction is used in comminuted or displaced fractures.
Nail length and width is estimated preoperatively by using implant templates.

Special Instruments

A full set of conventional, interlocking, bioabsorbable, and cannulated screws. Conical nuts and washers are useful in osteopenic patients.²
Periarticular bone-reduction clamps

Anesthesia

General or spinal anesthesia

Patient and Equipment Positions

Patient supine in radiolucent table with a folded drape to flex the knee 30 to 60 degrees
Image intensifier brought in across the uninjured leg

Surgical Procedure

Reduction, temporary fixation, and vertical 2- to 3-cm transpatellar tendon incision
Entrance portal identification and canal opening (Fig. 30–2). A ball-tipped guide is passed, and the canal is reamed 1.5 to 2 mm more than the planned diameter of the nail.
Guide exchange and manual nail insertion to 2 to 3 mm in the distal femur
Interlocking guide assembly, interlocking screws placement from lateral to medial and from distal to proximal, and incision closure (Fig. 30–3)
Control AP and lateral films are obtained before the patient leaves the room.