Treatment of intercondylar and supracondylar distal femur fractures using the GSH supracondylar nail.

From April 1990 to August 1994, the GSH supracondylar intramedullary nail (Smith & Nephew/Richards, Memphis, Tennessee) was used to treat 23 supracondylar femur fractures in 22 patients. Nineteen of the 23 fractures were highly comminuted and intra-articular. Fifteen patients with 16 fractures were followed up to healing or declaration of nonunion for an average of 10 months. All fractures were treated with direct reduction through a median parapatellar incision. Fixation of the intercondylar fractures was with 6.5-mm cannulated screws, and the GSH nail was then inserted between the screws to secure the articular segment to the shaft. Fifteen of the 16 fractures healed (94%) with excellent and good results at an average of 3.3 months. Initial postoperative fracture reduction was maintained in all patients until union, as shown by follow-up radiographs. Thirteen of the 16 patients were treated with immediate continuous passive motion of the knee. Average knee range-of-motion was 109 degrees. Complications included 1 nonunion, 1 delayed union, 1 hardware failure secondary to premature full weight-bearing, and 1 patient with impingement of the nail in the intercondylar notch. This impingement resolved with removal of the nail after fracture healing. The GSH supracondylar intramedullary nail is an excellent alternative for the treatment of supracondylar and intercondylar femur fractures.