SUPRACONDYLAR FEMO RAL FRACTURE THEERACHAI APIVATTHAKAKUL17 March 2011

Supracondylar Fractures Supracondylar Fractures

“ zone between femoral condyle “ zone between femoral condyle

and junction of metaphysis and junction of metaphysis

~9 cm.from articular surface” aaaaaaaaa aaaaaaaa9

DEFORMING MUSCLE

QUADRICEPS

HAMSTRINGS

GASTROCNEMIUS

Stewart MJ etal. JBJS 1966;48A Stewart MJ etal. JBJS 1966;48A

“ Additional trauma of surgery“ Additional trauma of surgery

and the proximity of metallic and the proximity of metallic

aa aaaaaa aa aaa aaaaa aaaaaaaaaa implants to the joint predispose

to excessive reaction and to excessive reaction and

subsequent adhesion lead to joint stiffness” subsequent adhesion lead to joint stiffness”

19746Schatzker et al. INJURY ; 1979SchatzkerandLambertCORR 19746Schatzker et al. INJURY ; a a a a1979

• - 7175% good to excellent result• - 7175% good to excellent result

•a aaaaaaa aaaaaa aaaa aaaaaaaaa• Accurate anatomical reduction

•aaaaaa aaaaaaaa aaaaaaaa• Stable internal fixation

•aaaaa a aaaaaaaaaaa• Early mobilization

ANATOMYANATOMYANATOMYANATOMY

• Surgical anatomy• Surgical anatomy

• Mechanical axis• Mechanical axis

• Anatomical axis• Anatomical axis

LATERAL VIEW LATERAL VIEW

• Anterior half• Anterior half

Blade position Blade position

• Posterior half• Posterior half

CROSS SECTION CROSS SECTION

• Trapezoid shape• Trapezoid shape

• aaaaaaaa a aaaaaaaaa>• Width anterior > posterior

• Medial ,lateral wall inclination• Medial ,lateral wall inclination

ANATOMY

LATERALVIEW

CROSS SECTION

ClassificationClassification

• severity of injury• severity of injury

• treatment• treatment

• prognosis• prognosis

AO CLASSIFICATION

CONSERVATIVE TREATMENT CONSERVATIVE TREATMENT

• Difficult articular reduction• Difficult articular reduction

• Posterior displacement• Posterior displacement

•aaaaa aaaaaaaaa• Joint stiffness

• Muscle atrophy• Muscle atrophy

CONSERVATIVE TREATMENT

- SINGLE PIN -DOUBLE PIN

OPERATIVE TREATMENT OPERATIVE TREATMENT

INDICATION FOR ORIF INDICATION FOR ORIF

•a aaaaaaaa aaaaa-aaaaaaaaaa aa.• - Displaced intra artricular Fx.

• aaaaaaaaaaaaaaaaaaaa aaaaaaaa,• Multiple injuries,ipsilateral injuries

• Most open fractures• Most open fractures

• Associated vascular injuries Associated vascular injuries• Associated vascular injuries Associated vascular injuries

•a aaaaaaaaaaa aaaaaaaa• Pathological fracture

• Irreducible fracture• Irreducible fracture

•un reducible fracture•un reducible fracture

-CONTRA INDICATION-CONTRA INDICATION

• Active infection• Active infection

• Severely contaminated open Fx.• Severely contaminated open Fx.

• Severe osteopenia• Severe osteopenia

• Inadequate facilities• Inadequate facilities

• Inexperienced surgeons• Inexperienced surgeons

LATERAL APPROACH TIBIAL TUBERCLEOSTEOTOMY

Tibial tubercle osteotomy Tibial tubercle osteotomy

• Complete articular exposure• Complete articular exposure

• - Pre drill tibial tubercle• - Pre drill tibial tubercle

• Fix to posterior cortex• Fix to posterior cortex

Tibial tubercle osteotomy

CONDYLAR BUTRESS PLATE

THANK YOU THANK YOU

SUPRACONDYLAR FEMO RAL FRACTURE THEERACHAI APIVATTHAKAKUL -AO BASIC COURSE 24 2

6 1998AUG,

What is your purpose for presentation in your practice?

• Lectures

• Podium presentation

Davos 2006

Davos 2008