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SUPRACONDYLAR FEMO RAL FRACTURE THEERACHAI APIVATTHAKAKUL17 March 2011
Supracondylar Fractures Supracondylar Fractures
“ zone between femoral condyle “ zone between femoral condyle
and junction of metaphysis and junction of metaphysis
~9 cm.from articular surface” aaaaaaaaa aaaaaaaa9
DEFORMING MUSCLE
QUADRICEPS
HAMSTRINGS
GASTROCNEMIUS
Stewart MJ etal. JBJS 1966;48A Stewart MJ etal. JBJS 1966;48A
“ Additional trauma of surgery“ Additional trauma of surgery
and the proximity of metallic and the proximity of metallic
aa aaaaaa aa aaa aaaaa aaaaaaaaaa implants to the joint predispose
to excessive reaction and to excessive reaction and
subsequent adhesion lead to joint stiffness” subsequent adhesion lead to joint stiffness”
19746Schatzker et al. INJURY ; 1979SchatzkerandLambertCORR 19746Schatzker et al. INJURY ; a a a a1979
• - 7175% good to excellent result• - 7175% good to excellent result
•a aaaaaaa aaaaaa aaaa aaaaaaaaa• Accurate anatomical reduction
•aaaaaa aaaaaaaa aaaaaaaa• Stable internal fixation
•aaaaa a aaaaaaaaaaa• Early mobilization
ANATOMYANATOMYANATOMYANATOMY
• Surgical anatomy• Surgical anatomy
• Mechanical axis• Mechanical axis
• Anatomical axis• Anatomical axis
LATERAL VIEW LATERAL VIEW
• Anterior half• Anterior half
Blade position Blade position
• Posterior half• Posterior half
CROSS SECTION CROSS SECTION
• Trapezoid shape• Trapezoid shape
• aaaaaaaa a aaaaaaaaa>• Width anterior > posterior
• Medial ,lateral wall inclination• Medial ,lateral wall inclination
ANATOMY
LATERALVIEW
CROSS SECTION
ClassificationClassification
• severity of injury• severity of injury
• treatment• treatment
• prognosis• prognosis
AO CLASSIFICATION
CONSERVATIVE TREATMENT CONSERVATIVE TREATMENT
• Difficult articular reduction• Difficult articular reduction
• Posterior displacement• Posterior displacement
•aaaaa aaaaaaaaa• Joint stiffness
• Muscle atrophy• Muscle atrophy
CONSERVATIVE TREATMENT
- SINGLE PIN -DOUBLE PIN
OPERATIVE TREATMENT OPERATIVE TREATMENT
INDICATION FOR ORIF INDICATION FOR ORIF
•a aaaaaaaa aaaaa-aaaaaaaaaa aa.• - Displaced intra artricular Fx.
• aaaaaaaaaaaaaaaaaaaa aaaaaaaa,• Multiple injuries,ipsilateral injuries
• Most open fractures• Most open fractures
• Associated vascular injuries Associated vascular injuries• Associated vascular injuries Associated vascular injuries
•a aaaaaaaaaaa aaaaaaaa• Pathological fracture
• Irreducible fracture• Irreducible fracture
•un reducible fracture•un reducible fracture
-CONTRA INDICATION-CONTRA INDICATION
• Active infection• Active infection
• Severely contaminated open Fx.• Severely contaminated open Fx.
• Severe osteopenia• Severe osteopenia
• Inadequate facilities• Inadequate facilities
• Inexperienced surgeons• Inexperienced surgeons
LATERAL APPROACH TIBIAL TUBERCLEOSTEOTOMY
Tibial tubercle osteotomy Tibial tubercle osteotomy
• Complete articular exposure• Complete articular exposure
• - Pre drill tibial tubercle• - Pre drill tibial tubercle
• Fix to posterior cortex• Fix to posterior cortex
Tibial tubercle osteotomy
CONDYLAR BUTRESS PLATE
THANK YOU THANK YOU
SUPRACONDYLAR FEMO RAL FRACTURE THEERACHAI APIVATTHAKAKUL -AO BASIC COURSE 24 2
6 1998AUG,
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