Supracondylar Fractures of the Femur

Abstract

A supracondylar fracture of the femur (Fig. 14.1) is a grave injury which for years represented an unsolved problem in trauma, and was considered to result almost always in varying degrees of permanent disability. It was felt that the fate of the joint was determined by the injury rather than by its treatment. Treatment was almost always closed and consisted principally of splinting and traction. The traction was applied either through a two-pin system, one through the supracondylar fragment and one through the tibial tuberosity, or through a single pin through the tibial tuberosity. The reduction was accomplished by traction or, if necessary, under general anesthesia. The extremity was then immobilized on a splint. Padding, flexion of the knee, and skeletal traction were used to maintain reduction. The difficulties with these methods were, first and foremost, an inability to control displaced intra-articular fragments which did not reduce with manipulation or traction, and secondly, that occasionally the supracondylar fragments displaced posteriorly. Further major drawbacks consisted of knee stiffness and the necessity for prolonged hospitalization and bed rest in the supine position which often exceeded 6–8 weeks.