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Supracondylar Femur Fractures Workup

  • Author: Steven I Rabin, MD; Chief Editor: Jason H Calhoun, MD, FACS  more...
 
Updated: Sep 28, 2015
 

Imaging Studies

Patients with supracondylar femur fractures require anteroposterior (AP) and lateral radiographs of the entire femur to assess associated fractures and deformity; however, views centered at the knee are also important to assess the specific fracture pattern.

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Staging

No specific staging system has been developed for supracondylar femur fractures; however, the Arbeitsgemeinschaft für Osteosynthesefragen (AO)-Association for the Study of Internal Fixation (ASIF) and Orthopaedic Trauma Association (OTA) classification systems help the surgeon determine appropriate treatment options.

The AO-ASIF classification divides supracondylar femur fractures into three main types, as follows:

  • A - Extra-articular
  • B - Partial articular
  • C - Complete articular

Type A is further divided into the following three subtypes:

  • A1 - Simple
  • A2 - Metaphyseal, wedge
  • A3 - Metaphyseal, complex

Type B is further divided into the following three subtypes:

  • B1 - Lateral condyle (sagittal fracture line)
  • B2 - Medial condyle (sagittal fracture line)
  • B3 - Frontal (coronal fracture line)

Type C is further divided into the following three subtypes:

  • C1 - Articular and metaphyseal segments, simple fractures
  • C2 - Articular simple, but metaphyseal multifragmentary fractures
  • C3 - Articular and metaphyseal segments, multifragmentary fractures
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Contributor Information and Disclosures
Author

Steven I Rabin, MD Clinical Associate Professor, Department of Orthopedic Surgery and Rehabilitation, Loyola University, Chicago Stritch School of Medicine; Medical Director, Orthopedic Surgery, Podiatry, Rheumatology, Sports Medicine, and Pain Management, Dreyer Medical Clinic; Chairman, Department of Surgery, Provena Mercy Medical Center

Steven I Rabin, MD is a member of the following medical societies: AO Foundation, American Academy of Orthopaedic Surgeons, American Fracture Association, Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Jason H Calhoun, MD, FACS Department Chief, Musculoskeletal Sciences, Spectrum Health Medical Group

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Michigan State Medical Society, Missouri State Medical Association, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, Texas Orthopaedic Association, Musculoskeletal Infection Society

Disclosure: Nothing to disclose.

Additional Contributors

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) Professor, Department of Orthopedic Surgery, University of Texas Medical School at Houston

James F Kellam, MD, FRCSC, FACS, FRCS(Ire) is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedic Trauma Association, Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

References
  1. Rabin SI, Carlson D, Rabin SL. Complications of Supracondylar Femur Fractures. Loyola U Orthopaedic J. 1995. 4:30-38.

  2. Shahcheraghi GH, Doroodchi HR. Supracondylar fracture of the femur: closed or open reduction?. J Trauma. 1993 Apr. 34(4):499-502. [Medline].

  3. Olerud S. Operative treatment of supracondylar--condylar fractures of the femur. Technique and results in fifteen cases. J Bone Joint Surg Am. 1972 Jul. 54(5):1015-32. [Medline].

  4. Schatzker J, Lambert DC. Supracondylar fractures of the femur. Clin Orthop. 1979 Jan-Feb. (138):77-83. [Medline].

  5. Johnson EE. Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur. Clin Orthop. 1988 Jun. (231):154-62. [Medline].

  6. Moore TJ, Watson T, Green SA, et al. Complications of surgically treated supracondylar fractures of the femur. J Trauma. 1987 Apr. 27(4):402-6. [Medline].

  7. Pritchett JW. Supracondylar fractures of the femur. Clin Orthop. 1984 Apr. (184):173-7. [Medline].

  8. Wu CC, Shih CH. Treatment of femoral supracondylar unstable comminuted fractures. Comparisons between plating and Grosse-Kempf interlocking nailing techniques. Arch Orthop Trauma Surg. 1992. 111(4):232-6. [Medline].

  9. Zehntner MK, Marchesi DG, Burch H, Ganz R. Alignment of supracondylar/intercondylar fractures of the femur after internal fixation by AO/ASIF technique. J Orthop Trauma. 1992. 6(3):318-26. [Medline].

  10. Yang RS, Liu HC, Liu TK. Supracondylar fractures of the femur. J Trauma. 1990 Mar. 30(3):315-9. [Medline].

  11. Mize RD, Bucholz RW, Grogan DP. Surgical treatment of displaced, comminuted fractures of the distal end of the femur. J Bone Joint Surg Am. 1982 Jul. 64(6):871-9. [Medline].

  12. Halpenny J, Rorabeck CH. Supracondylar fractures of the femur: results of treatment of 61 patients. Can J Surg. 1984 Nov. 27(6):606-9. [Medline].

  13. Newman JH. Supracondylar fractures of the femur. Injury. 1990 Sep. 21(5):280-2. [Medline].

  14. Crist BD, Della Rocca GJ, Murtha YM. Treatment of acute distal femur fractures. Orthopedics. 2008 Jul. 31(7):681-90. [Medline].

  15. Herrera DA, Kregor PJ, Cole PA, Levy BA, Jönsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: systematic review of 415 cases (1981-2006). Acta Orthop. 2008 Feb. 79(1):22-7. [Medline].

  16. Parvizi J, Jain N, Schmidt AH. Periprosthetic knee fractures. J Orthop Trauma. 2008 Oct. 22(9):663-71. [Medline].

  17. Kolb K, Koller H, Lorenz I, Holz U, Marx F, Grützner P, et al. Operative treatment of distal femoral fractures above total knee arthroplasty with the indirect reduction technique: a long-term follow-up study. Injury. 2009 Apr. 40(4):433-9. [Medline].

  18. Yoo JD, Kim NK. Periprosthetic fractures following total knee arthroplasty. Knee Surg Relat Res. 2015 Mar. 27 (1):1-9. [Medline].

  19. Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res. 2011 Apr. 469(4):1188-96. [Medline].

  20. Miller ME. The comprehensive classification of fractures of long bones. In: Miller ME, Allgower M, Schneider R, Willenegger H, eds. Manual of Internal Fixation. 3rd ed. New York, NY:. Springer-Verlag. 1991:140-1.

  21. Benirschke SK, Swiontkowski MF. Supracondylar femoral fractures. In: Hansen ST, Swiontkowski MD, eds. Orthopaedic Trauma Protocols. New York, NY:. Raven Press. 1993:294-308.

  22. Schatzker J. Supracondylar fractures of the femur. In: Schatzker J, Tile M, eds. The Rationale of Operative Fracture Care. New York, NY:. Springer-Verlag. 1987:255-273.

  23. Tscherne H. Extra-articular fractures of the distal femur. In: Miller ME, Allgower M, Schneider R, Willenegger H, eds. Manual of Internal Fixation. 3rd ed. New York, NY:. Springer-Verlag. 1991:548-51.

  24. Merchan EC, Maestu PR, Blanco RP. Blade-plating of closed displaced supracondylar fractures of the distal femur with the AO system. J Trauma. 1992 Feb. 32(2):174-8. [Medline].

  25. Giles JB, DeLee JC, Heckman JD, Keever JE. Supracondylar-intercondylar fractures of the femur treated with a supracondylar plate and lag screw. J Bone Joint Surg Am. 1982 Jul. 64(6):864-70. [Medline].

  26. Shelton ML, Grantham SA, Neer CS 2nd, Singh R. A new fixation device for supracondylar and low femoral shaft fractures. J Trauma. 1974 Oct. 14(10):821-35. [Medline].

  27. Siliski JM, Mahring M, Hofer HP. Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am. 1989 Jan. 71(1):95-104. [Medline].

  28. Zehntner MK, Ganz R. Internal fixation of supracondylar fractures after condylar total knee arthroplasty. Clin Orthop. 1993 Aug. (293):219-24. [Medline].

  29. Lucas SE, Seligson D, Henry SL. Intramedullary supracondylar nailing of femoral fractures. A preliminary report of the GSH supracondylar nail. Clin Orthop. 1993 Nov. (296):200-6. [Medline].

  30. Kolmert L, Egund N, Persson BM. Internal fixation of supracondylar and bicondylar femoral fractures using a new semielastic device. Clin Orthop. 1983 Dec. (181):204-19. [Medline].

  31. Shelbourne KD, Brueckmann FR. Rush-pin fixation of supracondylar and intercondylar fractures of the femur. J Bone Joint Surg Am. 1982 Feb. 64(2):161-9. [Medline].

  32. Pryor GA, Doran A. Fractures of the distal femur: the role of the Zickel supracondylar fixation device. Injury. 1988 Nov. 19(6):410-4. [Medline].

  33. Tulloch CJ, Calver RF. The use of Zickel supracondylar nails in the presence of a cemented hip prosthesis. Injury. 1988 Nov. 19(6):452-3. [Medline].

  34. Wu CC. Retrograde locked intramedullary nailing for aseptic supracondylar femoral nonunion following failed locked plating. J Orthop Surg (Hong Kong). 2015 Aug. 23 (2):155-9. [Medline].

  35. Seligson D, Kristiansen TK. Use of the Wagner apparatus in complicated fractures of the distal femur. J Trauma. 1978 Dec. 18(12):795-9. [Medline].

  36. Leino OK, Lempainen L, Virolainen P, Sarimo J, Pölönen T, Mäkelä KT. Operative Results of Periprosthetic Fractures of The Distal Femur In A Single Academic Unit. Scand J Surg. 2015 Sep. 104 (3):200-7. [Medline].

  37. Lee SS, Lim SJ, Moon YW, Seo JG. Outcomes of long retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty. Arch Orthop Trauma Surg. 2014 Jan. 134 (1):47-52. [Medline].

  38. Markel DC, Blasier RB, Edmunds MR. Technical tips for the fixation of supracondylar femur fractures with the sliding screw-plate device. Orthop Rev. 1992 Oct. 21(10):1247-50. [Medline].

  39. Zickel RE, Hobeika P, Robbins DS. Zickel supracondylar nails for fractures of the distal end of the femur. Clin Orthop. 1986 Nov. (212):79-88. [Medline].

  40. Leung KS, Shen WY, So WS, et al. Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur. J Bone Joint Surg Am. 1991 Mar. 73(3):332-40. [Medline].

  41. Kolb W, Guhlmann H, Windisch C, Marx F, Kolb K, Koller H. Fixation of distal femoral fractures with the Less Invasive Stabilization System: a minimally invasive treatment with locked fixed-angle screws. J Trauma. 2008 Dec. 65(6):1425-34. [Medline].

  42. Joseph FR. Evaluation of the Zickel supracondylar fixation device. Clin Orthop. 1982 Sep. (169):190-6. [Medline].

  43. Rabin SI, Humphreys SC, Podeszwa DA. Use of the Cobra Plate in severely comminuted Intercondylar Supracondylar Distal Femur Fractures. Loyola U Orthopaedic J. 1997. 6:32-37.

  44. Schneider R. Arthrodesis of the hip with the cobra plate. In: Miller ME, Allgower M, Schneider R, Willenegger H, eds. Manual of Internal Fixation. 2nd ed. New York, NY:. Springer-Verlag. 1979:338-9.

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Supracondylar femur fracture treated in traction. Traction allows nonoperative restoration of length and alignment while the patient is stabilized for surgery, but it is associated with the major complications of prolonged bedrest when used as definitive treatment.
Supracondylar femur fracture treated with a dynamic condylar screw plate. This device allows fixed-angle stabilization of the fracture, which usually prevents late loss of reduction, but it is technically limited because it cannot be used to fix multiple fragments.
Supracondylar femur fracture treated with a blade plate. This device allows fixed-angle stabilization of the fracture, which usually prevents late loss of reduction, but it is technically limited because it cannot be used to fix multiple fragments.
Supracondylar femur fracture treated with a supracondylar buttress plate. This device provides multiple holes for screw fixation of multiple fragments, but it is not a fixed-angle implant so it may allow late deformity.
Supracondylar femur fracture treated by retrograde intramedullary nail. Intramedullary devices are mechanically stronger than plates but have limited ability to control multiple fragments and require exposure through the knee joint.
Supracondylar femur fracture treated with Zickel flexible intramedullary rods. These devices act as an internal splint and can be placed rapidly with minimal blood loss and surgical exposure but do not control length and alignment.
Supracondylar femur fracture treated with external fixation and minimal internal fixation. This technique allows immediate restoration of length and alignment with minimal surgical exposure, but it often cannot hold the alignment in the long term and has associated problems with pin care.
Supracondylar femur fracture treated with a cobra plate. This device is strong and can achieve fixation in multiple fragments but is not fixed angle.
Supracondylar femur fracture treated with a tibial buttress plate. This type of plate is rarely used for these fractures but can allow low-profile fixation of stable fracture patterns. New periarticular plates are replacing this implant in this area.
 
 
 
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