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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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