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Krettek Christian M.D.; Miclau, Theodore M.D.; Stephan, Christine M.D.; Tscheme, Harald M.D.
Techniques in Orthopaedics: September 1999
Minimally Invasive Orthopaedics: Articles: PDF Only


Anatomic articular reconstruction is a primary goal in complex intraarticular fractures of the distal femur. Complete joint visualization, however, is difficult with the standard lateral approach (particularly with one that attempts to avoid soft tissue stripping). The authors developed a new minimally invasive approach and stabilization concept.14,16,17 This technique uses a lateral parapatellar arthrotomy for direct reduction of the joint surface and an indirect plate fixation technique to secure the articular block with the femoral shaft. In a prospective study conducted between 1992 and 1995, displaced Müller type C2-C3 intra-articular fractures of the distal femur were treated with a lateral parapatellar arthrotomy for direct reduction of the condylar block and an indirect plate fixation technique. There were seven closed and four open fractures (three grade II and one grade MB). Following reconstruction of the articular block, the block was indirectly reduced and fixed to the shaft by a plate inserted retrograde beneath the vastus lateralis. Transcutaneous/transmuscular screws were used to fix the plate to the shaft. Radiographic union was achieved at a median of 13.1 weeks (range, 8.0-17.1 wks) without needing primary or secondary bone grafts. No infections or refractures occurred. There were no revisions except for two cases, which required a corrective osteotomy malalignment. According to the Neer score, there were five excellent results, three satisfactory, and two unsatisfactory results, with no failures; in one case, the Neer score could not be obtained. The treatment of complex supracondylar/intracondylar distal femur fractures treated with this technique compare favorably with other reported series using different techniques, without the added morbidity associated with autogenous bone grafting. However, the surgical technique is demanding and special care must be taken to ensure correct axial alignment.

© 1999 Lippincott Williams & Wilkins, Inc.