AP view of a comminuted C3 intraarticular distal femur fracture'

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AP view of a comminuted C3 intraarticular distal
femur fracture.
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Lateral view demonstrating the typical extension
deformity caused by the pull of the origin of the
gastrocnemius muscles from the posterior distal
femur.
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These figures demonstrate the intracondylar
extension of the fracture and a free
intercondylar fragment (arrows).
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FEMORAL AXIS
PLANNED SCREW POSITIONS
When planning for the lag screw fixation, the
surgeon must leave room for the lag screw of the
fixed angle device or intramedullary nail.
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A 7-10cm lateral parapatellar incision is made
which can be extended proximally into a formal
lateral approach to the femur if necessary. The
intercondylar reduction is performed through this
limited arthrotomy.
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Periarticular or standard clamps are used to
manipulate and reduce the fracture which is
stabilized with the templated 6.5 mm lag screws
with washers. The screws are placed anterior and
posterior to the planned position of the fixed
angle device.
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Note the anatomic reduction of the articular
surface. At this point, the articular surface is
reconstructed and the metaphyseal component
of the fracture is still unfixed.
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LATERAL VIEW
AP VIEW
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LATERAL VIEW
AP VIEW
AP and lateral radiograph demonstrating the
position of the lag screw as templated. Note
that with traction, both the AP and
lateral radiographs are manipulated such that the
metaphysis is reduced.
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LATERAL VIEW
AP VIEW
This requires a bolster underneath the
metaphyseal fracture and some flexion of the knee
to correct the extension deformity of the
quadriceps. The dotted line represents the axis
of the femur where the plate will be placed.
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AP radiograph demonstrating the angle at which
the guidewire for the fixed angle lag screw
should be placed. It should be parallel with the
distal femoral articular surface, which is at
approximately 95o to 98o from the femoral shaft.
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After the lag screw is placed, the appropriate
sized fixed angle plate is slid subperiosteally
up the femur. Notice the bolster, which is
supporting the fracture in a reduced position.
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After the plate is advanced subperiosteally up
the femur, the distal fragment is manipulated
such that the plating engages the lag screw.
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After the plate is advanced subperiosteally up
the femur, the distal fragment is manipulated
such that the plating engages the lag screw.
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AP VIEW
LATERAL VIEW
AP and lateral radiographs demonstrating that the
plate is against the femur and the metaphysis is
generally reduced.
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The lateral radiograph can be used in a similar
fashion to a perfect circle technique used in
nailing to place the proximal screws
percutaneously.
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A percutaneous incision is used to allow for the
placement of three screws through this incision.
This image demonstrates the drill being
introduced percutaneously into the hole and
drilling through the plate into the femur.
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The first screw is the most proximal to seat the
plate.
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As the most proximal screw is placed, it pulls
the femoral shaft against the plate.
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As the most proximal screw is placed, it pulls
the femoral shaft against the plate.
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As additional screws are placed, better fixation
of the proximal fragment is obtained.
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The final radiograph demonstrating the
parapatellar incision for reduction of the joint
and the percutaneous incisions utilized for the
placement of the screws.
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The size of the plate held up against the leg
after fixation.
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Immediate postoperative AP radiograph
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Lateral radiograph immediately postoperative,
demonstrating anatomic alignment of the
metaphyseal region, as well as the joint.
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LATERAL VIEW
AP VIEW
AP and lateral radiographs demonstrating early
callus formation at six weeks.