12/7/2023 0 Comments Supracondylar fracture femurSecondary procedures are required in approximately 20% of cases ( Fig. Unilateral, ring, or hybrid fixators can be used (see Fig. Fractures that are considered for external fixation fall into the above-mentioned categories and are typically complex nonarticular (OTA A3), and complex bicondylar (OTA C3). The latter can add problems such as quadriceps scarring.Įxternal Fixation: As noted in previous chapters, external fixation is particularly useful in multitrauma patients, with complex fractures and when there are open wounds that require easy wound access. A single pin can be placed in the proximal tibia with the option of a second pin in the distal femoral fragment (see Fig. Single or double traction pins may be used. Traction: Traction is a useful temporary approach to comminuted fractures or when patient status will not allow primary definitive fixation. Reduction may be difficult to maintain due to muscle forces acting on the fragments. Both closed and open techniques may be employed depending on the patient status (i.e., other injuries) and the type of fracture. The goals for treatment are to restore alignment and articular anatomy. Orthopaedic Trauma Association Committee on Coding and Classifications. 6-4E)Ĭ3-both condyles, all segments comminuted Type C: Complete articular, both condyles involved withĬ2-both condyles, multiple metaphyseal fragments ( Fig. 6-4C)ī1-lateral condyle, sagittal fracture lineī2-medial condyle, sagittal fracture line Type B: Partial articular, one condyle involved ( Fig. Type A: Extra-articular, simple, or comminutedĪ2-metaphyseal, wedge ( Fig. There are multiple classification systems based on extra-articular, one or more condyle involvement, the plane of the fracture, and the degree of comminution.Ĭlassification: Orthopaedic Trauma Association (see Fig. Injuries are usually related to high-velocity trauma such as motor vehicle accidents in younger patients or due to more minor trauma in the elderly. The mechanism of injury is usually varus or valgus stress with associated axial or rotary forces. Approximately 5% to 10% of supracondylar fractures are open injuries, usually anterior and proximal to the patella. Associated injuries of the tibial plateau, proximal tibia, proximal femur, and soft tissues of the knee are common. Fractures may be impacted, undisplaced, comminuted, and involve the articular surface of the femur. These fractures are relatively uncommon, accounting for only 7% of femoral fractures. Supracondylar fractures of the femur are fractures involving the distal 9 to 15 cm, as measured from the articular surface of the femoral condyles. Comparison of CT and MRI in patients with tibial plateau fractures: Can CT findings predict ligament tear or meniscal injury? Skeletal Radiol. Osseous and myotendinous injuries about the knee. 6-3) and soft tissue supporting structures.īerquist TH. Magnetic resonance imaging (MRI) is also able to detect subtle osseous injuries as well as evaluate the articular cartilage (see Fig. When indicated, computed tomography (CT) is useful to further evaluate suspected fractures or fragment position (see Fig. These views are useful for detection of patellar fracture or alignment abnormalities and osteochondral injuries. Additional views, such as the notch or patellar views, should be considered if the patient can tolerate the necessary positioning. 6-1E and F) should be obtained using cross-table lateral technique because a lipohemarthrosis may be the only indication of a subtle intra-articular fracture. Therefore, anteroposterior (AP), lateral, and both oblique views (see Fig. Patients may not be able to tolerate special views. Imaging of the knee in patients with suspected trauma is different from certain other indications.
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