Indirect reduction and internal fixation of supracondylar femur fractures without bone graft.

Thirty supracondylar-intercondylar fractures of the distal femur were treated in a prospective series using an indirect reduction technique. From January 1988 to July 1993, patients who entered into this protocol had undergone fixation with a distal lateral plate without stripping of the medial soft tissues and without bone graft. With this technique, 86.6% excellent and satisfactory results were achieved using the Neer rating system. Of the three failures, two were in elderly, osteoporotic women with comminuted intraarticular fractures, and one failure occurred in a renal transplant patient with bilateral quadriceps ruptures despite a good result from her femur fracture. Only one patient with a grade 2 open fracture and comminution developed a nonunion, which eventually healed after bone grafting. The results of this technique compare favorably with other series of osteosynthesis of supracondylar femur fractures in the orthopaedic literature without the added morbidity associated with autogenous bone grafting. The surgical technique is demanding and may not be suitable for patients with severe open fractures with devascularized bony fragments or marked osteoporosis.