Importance of maintenance medial buttress in treatment of supra-condylar and inter-condylar(T-condylar) fracture of the femur

Yune, Seung Ho; Rhee, Kwang Jin; Park, Chan Hee; Byun, Ki Yong; Lee, Sang Yong; Rho, Seung Kwon

Abstract

Recently, treatment of supracondylar and intercondylar(T-condylar) fracture of the femur has been changed from conservative treatment to do open reduction and internal fixation. Principles of anatomical reduction, rigid internal fixation and early knee joint exercise are recommended, but there are many difficulties and problems to get anatomial reduction and rigid internal fixation. we observed 3 cases of malunion & nonunion that were treated by ORIF. In these cases, there is a failure in restoring medial buttress of distal femur due to inadequate reduction and internal fixation. Dynamic condylar screw(DCS) or blade plate were usually used through lateral approach and laterally applying method can not always restore the medial buttress of the fracture site. In these cases, early exercise and early weight bearing have to be postponed,and the results were poor. So we want to emphasize the principles in open reduction and internal fixation of the supra-and inter-condylar fracture fo the femur. To get anatomecal reduction is very important, but if is not possible in severely comminuted fractures, we have to try to maintain medial buttress by another methods such as double plating(to add a medial auxiliary buttress plate to lateral internal fixation) or auxiliary external fixations instead of medial anatomical contact.