A supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. This does not cause functional disability and should not be treated with physiotherapy. Supracondylar humeral fracture radiology reference. In addition to the t2 femoral nailing system, stryker developed the t2 supracondylar nail scn for the treatment of complex distal femoral fractures. Patients suffering a distal femoral fracture are at a high risk of morbidity and mortality.
Pt was riding on a country road when he accidentally hit an obstacle and was ejected from his motorcycle. Distal femur fracture ao type a and c1, open wound around the knee, bilateral femur fractures, ipsilateral segmental fracture and severe obesity. Unicondylar fractures of the distal femur are rare lesions, that often occur in combination with other posttraumatic injuries and may therefore fail to be recognised initially. The lateral cortex of the femur has a 10 degree slope, and the medial cortex slopes 25 degrees. This type of cornoal fractures of he distal femur are further classified into. Documentation of neurovascular status in supracondylar. If the fractures around hip are excluded, 31% femoral fractures involve distal portion 1. Treatment of resistant nonunion of supracondylar fractures femur by megaprosthesis. Ppt fractures of the distal femur powerpoint presentation. Early weight bearing on supracondylar distal femur fractures. Thighbone femur fractures in children ortho 4 states. This rare injury corresponds to the orthopaedic trauma association type 33b3 fracture frontal, partial articular fracture of the distal femur.
Garden city hospital 1998 introduction 47% of all femur. Supracondylar femur fractures clinical presentation. Supracondylar fractures are the most common type of upper arm injury in children. The femur is the largest and strongest bone in the body. Sickkids parent information sheet supracondylar humerus fracture without displacement. This case report includes two elderly patients who sustained supracondylar femur fractures that failed to unite with standard operative fixation methods. A comparison of mortality following distal femoral fractures. Pediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 57 years of age, usually from a fall on an outstretched hand.
This procedure is the fixation of the thighbone femur using a nail, plate, rod and screws. Casts and braces may not work well with this type of fracture, unless it is stable and the bone pieces are well aligned. Distal femur fractures orthopaedic trauma association. Management of fractures of distal femur journal of medical.
Indications for retrograde im nailing for the treatment of distal femur fractures include 16,19,21,22. Surgical treatment of this fracture is used to reduce morbidity, together with. They are typically sustained in highimpact trauma, such as car crashes, due to the large amount of force needed to break the bone. Chapter 53 fractures of the distal femur china quad diaries. Unicondylar fractures of the distal femur emconsulte. Simple supracondylar fractures are typically seen in younger children, and are uncommon in adults. Supracondylar femur fracture orif ostrum 2 years ago this video demonstrates the approach, reduction, and internal fixation of an intraarticular supracondylar distal femur fracture with a hoffa fracture using a distal femoral locking plate. Unicondylar fractures of the distal femur sciencedirect.
Clinical outcomes of locked plating of distal femoral. But with supracondylar femoral fracture, the muscles in the thigh often contract and pull the bone pieces apart. The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. A new anterolateral approach for type c fractures of the distal femur. This injury can involve the cartilage on the base of the femur in the knee joint, and may increase the risk of developing knee arthritis later in life. Supracondylar soopruhkondehlahr femoral fracture also called distal distuhl femur fracture is when the thigh bone breaks at the knee. Distal femur fractures and its treatment with distal femur. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion nu, and revision is limited.
The fracture line was sagittal in 82% of cases and coronal hoffa fracture in. Currently this cohort is not afforded the same resources as those with hip fractures. Pt landed on a flexed right knee and rolled over to the right side on the ground. This condition is a break in the femur at the knee joint. Early weight bearing on supracondylar distal femur fractures in elderly patients the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Comparison of supraintercondylar and supracondylar femur. Jan 10, 2016 summary every surgically managed fracture is a race between bony union and implantbiological failure leading to nonunion. The incidence of supracondylar fracture after total knee arthroplasty is approximately 1%. Fractures of the distal femur the supracondylar fracture distal femur fractures j. Ppt distal femur fractures powerpoint presentation free. The fracture can range from a small crack to a full break that allows part of the bone to separate. Distal femur fractures indirect reduction not for articular surfaces direct visualization and reduction preserves softtissue envelope around metadiaphyseal. Distal femur fractures and its treatment with distal femur locking plate kanav padha, sandeep singh, abdul ghani, harish dang the incidence of distal femur fractures is around 37 100,000 patients per year. In case of young people, it occurs due to highenergy trauma.
Supracondylar fracture pediatric pediatrics orthobullets. Dec 18, 2017 a supracondylar fracture is an injury to the humerus, or upper arm bone, at its narrowest point, just above the elbow. Outcome of retrograde intramedullary nailing and locking. Supracondylar femur fractures orthopaedicsone articles.
Lateral and ap view of two year old girl with gartland type ii supracondylar fracture. The backslab and sling should be placed under figure 2. The normal anatomic axis of the distal femur is 6 to 7 degrees of valgus in a male and 8 to 9 degrees in a female. Ota video library supracondylar femur fracture orif. Thighbone femur fractures in children the thighbone femur is the largest and strongest bone in the body. Listing a study does not mean it has been evaluated by the u. Supracondylar fractures of the femur 33a, b, and c. Patients with unicondylar fractures of the distal femur were included. The lateral and medial condyles were equally affected. Pdf supracondylar fracture of the femur in children.
On the ap view, fracture lines can be seen through the metaphyseal bone of the distal humerus on either side of the olecranon fossa. The purpose of this paper is to report the use of total knee arthroplasty, a megaprosthesis, as a treatment in elderly patients who have a persistent nonunion of a supracondylar femur fracture. Babst department of trauma surgery, cantonal hospital lucerne, lucerne, switzerland summary this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. Femoral shaft fractures orthopaedic trauma association. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. Dec 07, 2015 the socalled hoffa fracture refers to an isolated, coronallyoriented fracture of either femoral condyle, with intraarticular extension. Distal femur fractures represents about 7% of all femur fractures in adults, and are notoriously difficult to treat. The purpose of this study was to analyze the complications and clinical outcomes of lp treatment for distal femoral fractures. Cause statistics the most common cause of thighbone fractures in infants under 1 year old is child abuse. Any pathological fracture except due to osteoporosis method of study every patient was evaluated after history, clinical examination and radiological investigation and fracture pattern was classified according to ao classification. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee replacement surgery. Femur fractures are common among trauma patients and are typically seen in patients with multiple injuries resulting from.
Cross pinning technique used to stabilize supracondylar fracture of femur adversely affects flexion angles of stifle joint leading to joint stiffness compared to either of the end threaded pinning. A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. There are different kinds of breaks, from simple to serious. This type of fracture is associated with the injuries of the pelvis, hip, and knee, and considered as the major crack in the thigh bone. Unreamed antegrade unreamed nailing was performed with protection of the proximal fragment with cerclage wires. Schatzker j, horne g, waddell j 1974 the toronto experience with the supracondylar fracture of the femur 19661972. Nonphyseal supracondylar fractures of the femur are considered to be uncommon in children and have received little attention in the literature.
Krishnamoorty summary a retrospective study of 34 patients with. Optimal timing of femur fracture stabilization in polytrauma patients. These fractures usually occur in elderly patients with multiple comorbidities and osteoporotic bone. The proximal femoral fracture in the elderly is a serious public health problem. The most common cause of a fracture is direct trauma to the leg from an automobile accident or a fall. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. With intercondylar split fracture patterns, the two heads may also cause the distal condylar fragments to separate and rotate. On lateral view the anterior humeral line is anterior to the middle of capitellum. Gartlands classification of supracondylar fracture of humerus galeazzi fracture a fracture of the radius with dislocation of the distal radioulnar joint colles fracture a distal fracture of the radius with dorsal posterior displacement of the wrist and hand smiths fracture a distal fracture of the. The best suitable fda approved implant for a particular fracture pattern of distal femur was used.
May 04, 2016 the b3 type fracture popularly known as hoffas fracture has immense clinical signifcance in the outcome following treatment and has been further subdivided into three types 3,8,10. But when nonunion occurs, it becomes a challenging task for the surgeon and patient both. The femur is the largest and strongest bone in the body, so it takes tremendous force to cause a fracture. The socalled hoffa fracture refers to an isolated, coronallyoriented fracture of either femoral condyle, with intraarticular extension. Exclusion criteria were pathological fracture, periprosthetic fracture of the knee, child younger than 15 years and 3 months, and epiphyseal separation. Gartlands classification of supracondylar fracture of humerus. Pdf treatment of resistant nonunion of supracondylar. Nail will not have an isthmic fit may need blocking pinsdrill bitsscrews percutaneous or open clamps nail will lock a fracture in a malreduced position as easily as it will. A satisfactory result based on modified mize criteria was achieved in 50 % of supraintercondylar fractures and in 79. Management of acute distal femur fracture with a nail or plate has good union rate or more than 90%. Fracture, femoral shaft childrens hospital colorado. Patients with supracondylar fractures will often have prolonged period months of inability to fully extend their elbow. Supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment.
The fracture line was sagittal in 82% of cases and coronal hoffa fracture in 18% of cases. Supracondylar femoral fracture central coast orthopedic. Open supracondylar fracture of femur short description. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. Hoffa fracture of the femoral condyle pubmed central pmc. They are caused by a direct impact on the flexed knee during weight bearing. Summary every surgically managed fracture is a race between bony union and implantbiological failure leading to nonunion. Supracondylar distal femoral nonunions treated with a megapr. No loc, helmet on, unable to ambulate 22 severe right knee and thigh pain. Timing of femoral shaft fracture fixation affects length of hospital. In general, casts and braces can hold fractured bones in place as you heal.
It take a great deal of force to break the thigh bone. The fracture line starts in the lateral or medial intercondylartrochlear groove. Supracondylar fracture definition of supracondylar fracture. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter see hip fractures. Raise the arm on a pillow when sitting or lying down loose fitting clothing, not through the sleeve. Supracondylar humeral fractures are the second most common fracture type in children. As the most commonly fractured long bone, it is not surprising that the femur was the first bone in which internal fixation was attempted. To study the incidence and pattern of supracondylar femur fractures according to aoasif classification, to assess the treatment and longterm functional outcome for supracondylar femoral fracture using retrograde nail. Physical therapy in the postoperative of proximal femur fracture in. This study aims to compare their mortality rates and assess whether surgical intervention improves either outcome or mortality following distal femoral fractures. Distal femur fracture, new anterolateral approach, anatomy. Oct, 2017 supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. Locked plating lp of distal femoral fractures has become very popular.
The fracture was due to a highenergy trauma in 51% of cases. The anatomy of the distal femur explains the three major types of fracture. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. A free powerpoint ppt presentation displayed as a flash slide show on id.
Risks of a fractured femur there are risks and complications with this procedure. At latest followup, 9 month after the injury, uneventful healing of the femur fracture had occurred. A femoral fracture is a bone fracture that involves the femur. The number of highenergy traumas causing distal femoral fractures is increasing. Infection can occur, requiring antibiotics and further treatment. Use of cbps for supraintercondylar and supracondylar femur fractures treatment led to a high union rate.
These fractures are more commonly seen in boys 4 these injuries are almost always due to accidental trauma, such as falling from a moderate height bedmonkeybars 4. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. Midshaft femur fracture all subtrochanteric pediatric hip pain. Fractures of the distal femur whether supracondylar. Distal femur lecture orthopaedic trauma association. It tends to occur in osteoporotic bones in the elderly due to lowenergy trauma. Supracondylar medical definition merriamwebster medical. Supracondylar femur fracture is a rare but devastating complication.