SUPRACONDYLAR FEMORAL FRACTURE THEERACHAI APIVATTHAKAKUL 17 March 2011

Supracondylar Fractures “ zone between femoral condyle and junction of metaphysis ~9cm.from articular surface”

DEFORMING MUSCLE QUADRICEPS HAMSTRINGS GASTROCNEMIUS

Stewart MJ etal. JBJS 1966;48A “Additional trauma of surgery and the proximity of metallic implants to the joint predispose to excessive reaction and subsequent adhesion lead to joint stiffness” subsequent adhesion lead to joint stiffness”

Schatzker et al. INJURY 1974;6 Schatzker and Lambert CORR 1979 Schatzker et al. INJURY 1974;6 Schatzker and Lambert CORR % good to excellent result Accurate anatomical reduction Stable internal fixation Early mobilization

ANATOMYANATOMY Surgical anatomy Mechanical axis Anatomical axis

LATERAL VIEW Anterior half Blade position Posterior half

CROSS SECTION Trapezoid shape Width anterior > posterior Medial,lateral wall inclination

ANATOMY LATERAL VIEW CROSS SECTION

ANATOMICA L AXIS MECHANICA L AXIS

Classification severity of injury treatment prognosis

AO CLASSIFICATION

CONSERVATIVE TREATMENT Difficult articular reduction Posterior displacement Joint stiffness Muscle atrophy

CONSERVATIVE TREATMENT SINGLE- PINDOUBLE-PIN

OPERATIVE TREATMENT

INDICATION FOR ORIF Displaced intra-artricular Fx. Multiple injuries,ipsilateral injuries Most open fractures Associated vascular injuries Associated vascular injuries Pathological fracture Irreducible fracture unreducible fracture

CONTRA-INDICATION Active infection Severely contaminated open Fx. Severe osteopenia Inadequate facilities Inexperienced surgeons

LATERAL APPROACHTIBIAL TUBERCLE OSTEOTOM Y

Tibial tubercle osteotomy Complete articular exposure Pre-drill tibial tubercle Fix to posterior cortex

Tibial tubercle osteotomy

PRE-OP PLANNING Surgical approach Step of procedure Type,size of implant Decrease surgical time,infection

OPERATIVE POSITION SURGICAL APPROACH Supine,radiolucent table Lateral approach Anterolateral approach Medial approach

RETROGRADE INTRAMEDULLY NAIL

CONDYLAR BUTRESS PLATE

Osteoporotic Fracture

THANK YOU

SUPRACONDYLAR FEMORAL FRACTURE THEERACHAI APIVATTHAKAKUL AO BASIC COURSE AUG,1998

What is your purpose for presentation in your practice? Lectures Podium presentation

Davos 2006

Davos 2008