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7/31/2019 Hospital Presentation Tella

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HOSPITAL PRESENTATION

PINK TEAM

WEDNESDAY 21-03-12


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CLASSIFICATION OF

SUPRACONDYLAR FEMORAL

FRACTURES

TELLA A. O.

21ST MARCH 2012


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OUTLINE

INTRODUCTION

RELEVANT ANATOMY

INCIDENCE MECHANISMS OF INJURY

CLASSIFICATION

CLINICAL IMPLICATIONS CONCLUSION


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INTRODUCTION

Distal femoral fractures:

- Supracondylar (Distal femoral metaphysis)

- Intercondylar (Articular)

Supracondylar femoral fractures are common,

seen in our day to day practice

Often difficult to treat and are notorious for

many complications


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RELEVANT ANATOMY

The supracondylar region of the femur refers

to the zone between the distal articular

surface and the junction of the femoal

diaphysis and metaphysis

Comprises the distal 9 cm of the femur

Within this region the geometry and the

function of the bone changes from weight

bearing to articulation.


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Cortical thinning and an increase in cancellous

bone also occurs in this transition from the

diaphysis to the metaphysis.


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The alignment of the

femoral shaft is an

important consideration

in supracondylarfemoral fractures.

The anatomical axis is in

valgus and subtends

angle of 9 with theknee joint axis


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Other importantcharacteristics of thisarea include theanteriorly locatedtrochlea for patellararticulation and theposterior intercondylarnotch.

The distal femurappears trapezoidal oncross section.


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On the lateral view the

bulk of the femoral

condyles lie posterior to

the long axis of thefemur and widen as

they extend backwards.

The anterior portion

appears as continuationof the shaft.


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The muscles about thedistal femur producecharacteristic bonydeformities anddisplacement patterns

following fracture. The quadriceps and

hamstrings causeshortening of the femurwhile the gastroc muscles

act to rotate the condylesposteriorly placing the distalfragment into relativeextension.


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INCIDENCE

The incidence of supracondylar fractures is 4

to 7% of all femoral fractures.

If hip fractures are excluded, one-third of

femoral fractures involve the distal portion.

Open fractures occur in 5% to 10% of all distal

femoral fractures.

There is a bimodal distribution of these

fractures.


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BIMODAL DISTRIBUTION

Young

Male

40 years High energy

MVA

Elderly

Female

50 years Low energy

Falls

Osteoporotic bones


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MECHANISM OF INJURY

Most distal femur fractures are result of a

severe axial load with a varus, valgus, or

rotational force.

Fracture displacement, comminution and

open wound may be seen in the young.

Trivial trauma on a flexed knee usually the

cause in the elderly with osteoporotic bones.


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The deformity seen is produced by- Initial trauma- Muscle forces

Associated injuries may be seen- Knee ligament injury (20%)- Patella fracture (15%)- Tibia plateau fracture- Vascular injury (3%)- Neurological injury ( 1%)


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CLASSIFICATION

Descriptive classification:

- Open versus Closed

- Pattern (transverse, oblique or spiral)

- Angulation (varus, valgus or rotationaldeformity)

- Comminuted, segmental or butterfly

segment- Articular involvement


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The Neer classificationwas first introduced byCharles Neer in 1967. Itwas simple but it reallyfailed to provide much inthe way of clinical andprognostic information.

Type I fractures werethose that were minimallydisplaced

Type II fractures were

based on the direction ofdisplacement of thecondyles (medially orlaterally relative to theshaft).

Type III Neer fractures areany fractures withcomminution.


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Seinsheimer in 1980published a classification offractures of the distal femurbased on his experience.

His classification divided the

fractures into groups basedon location and degree ofcomminution.

Type I : Any fracture of lessthan 2 mm displacement.

Type II : Fractures involvingdistal metaphysis withoutintercondylar extension (A& B).

Type III : Any condylar

injuries extending into theintercondylar notch (A, B &C).

Type IV : Articular fracturesthat went outside of the

intercondylar notch throughthe articular surface eithermedially or laterally (A, B &C).


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MULLER (AO/OTA) CLASSIFICATION

Originally developed by Maurice Muller in the

1960's.

Classified supracondylar fractures into three main

types baesd on articular involvement andcomminution.

It has been adopted by the OTA as a classification

of choice and is included in the OTA compendiumof all fracture and dislocation classifications for

the entire musculoskeletal system.


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Type A: Extra-articular

- A1 : Simple, two-part

fracture

- A2 : Metaphysealwedge fracture

- A3 : Comminuted

supracondylar fracture.


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Type B: Partial articular

or Unicondylar

- B1: Lateral condyle,

sagittal- B2: Medial condyle,

sagittal

- B3: Coronal or Hoffa

fracture


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Type C: Complete

articular or Bicondylar

- C1: Articular simple,

metaphyseal simple Tor Y fracture

- C2: Articular simple,

metaphyseal complex

fracture- C3: Articular complex

fracture


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CONCLUSION

The aim of fracture classification is to guide

approaches to treatment and serve as basis

for comparison of results of treatment.

The AO/OTA system has been excellent in this

regard.

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