Sanders R, Swiontkowski M, Rosen H, Helfet D
Vanderbilt University Medical Center, Nashville.
J Bone Joint Surg Am. 1991 Mar;73(3):341-6.
The cases of nine patients who had a complex fracture of the distal part of the femur and a deficient medial-cortical buttress were reviewed. Stable fixation was not achieved with the lateral condylar buttress plate alone. Collapse of the distal fragment into varus angulation was noted intraoperatively, with the axis of rotation being the junction of the distal screws and the plate. Additional stabilization with a medial plate and a bone graft from the iliac crest was applied in all nine patients: in six, at the time of the index operation and in the remaining three, after the open wound and open fracture were considered clean. At an average duration of follow-up of twenty-six months (range, twenty-one to thirty-four months), all of the fractures had healed. Evaluation of the functional outcome revealed five good and four fair results. In three patients, less than 90 degrees of flexion of the knee was present and in six, the arc of flexion was limited to between 90 and 100 degrees. Additionally, four patients had an extensor lag of 5 degrees.
回顾了9例股骨远端复杂骨折且内侧皮质支撑不足患者的病例。仅使用外侧髁支撑钢板无法实现稳定固定。术中发现远端骨折块向内翻成角塌陷，旋转轴为远端螺钉与钢板的交界处。所有9例患者均采用内侧钢板及取自髂嵴的骨移植进行额外稳定：6例在初次手术时进行，其余3例在开放伤口和开放性骨折被认为清洁后进行。平均随访26个月（范围21至34个月），所有骨折均已愈合。功能结果评估显示5例良好，4例尚可。3例患者膝关节屈曲小于90度，6例患者屈曲弧度限制在90至100度之间。此外，4例患者存在5度的伸肌滞后。
