[Treatment of intraarticular comminuted supracondylar femoral fractures by indirect plate osteosynthesis].

Objectives: We evaluated the effectiveness of indirect plating, which is accepted as a biological fixation, in intraarticular comminuted supracondylar femoral fractures.

Methods: Six patients (4 males, 2 females; mean age 35 years; range 14 to 54 years) had distal femoral fractures of Muller type 33.C2 (n=3) and 33.C3 (n=3). There were three closed and three open fractures; of open fractures, two were type II and one was type III according to the Gustilo-Anderson classification. Intraarticular fractures were reconstructed directly through a lateral parapatellar incision, while supracondylar fractures were indirectly reduced without surgical exposure of the fracture site. The distal anatomically reconstructed articular block was fixed to the femoral shaft by a plate inserted retrogradely beneath the vastus lateralis muscle, followed by plate fixation to the femoral shaft by cortical screws sent percutaneously through stab incisions or transmuscularly through limited proximal incisions. The mean follow-up was 25 months (range 12 to 40 months).

Results: The average time until union was 15 weeks (range 12 to 20 weeks). No refractures, implant failures, or infections were encountered. Two patients had restricted knee movements (25% to 50%), three had leg length discrepancy (1 to 2.5 cm), and one patient had a valgus deformity of 10 degrees. According to the Johner and Wruhs criteria, the results were as follows: excellent in one patient, good in one patient, satisfactory in two, and poor in two patients. All patients returned to preinjury activity levels.

Conclusion: Biological plate fixation is effective and may be considered an alternative to other conventional surgical methods in the treatment of distal intraarticular complex supracondylar femoral fractures.