2. SUPRACONDYLAR FEMORAL FRACTURE THEERACHAI APIVATTHAKAKUL 17 March 2011

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

4. DEFORMING MUSCLE QUADRICEPS HAMSTRINGS GASTROCNEMIUS

5. 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”

6. Schatzker et al. INJURY 1974;6 Schatzker and Lambert CORR 1979 Schatzker et al. INJURY 1974;6 Schatzker and Lambert CORR 1979 71-75% good to excellent result Accurate anatomical reduction Stable internal fixation Early mobilization

7. ANATOMYANATOMY Surgical anatomy Mechanical axis Anatomical axis

8. LATERAL VIEW Anterior half Blade position Posterior half

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

10. ANATOMY LATERAL VIEW CROSS SECTION

11. ANATOMICA L AXIS MECHANICA L AXIS

12. Classification severity of injury treatment prognosis

13. AO CLASSIFICATION

14. CONSERVATIVE TREATMENT Difficult articular reduction Posterior displacement Joint stiffness Muscle atrophy

15. CONSERVATIVE TREATMENT SINGLE- PINDOUBLE-PIN

16. OPERATIVE TREATMENT

17. 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

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

19. LATERAL APPROACHTIBIAL TUBERCLE OSTEOTOM Y

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

21. Tibial tubercle osteotomy

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

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

24. RETROGRADE INTRAMEDULLY NAIL

25. CONDYLAR BUTRESS PLATE

26. Osteoporotic Fracture

27. THANK YOU

28. SUPRACONDYLAR FEMORAL FRACTURE THEERACHAI APIVATTHAKAKUL AO BASIC COURSE 24-26 AUG,1998

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

30. Davos 2006

31. Davos 2008