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Small-fragment cortical lag screws maintained reductionin coronal plane fractures
Radiographic union with no displacement of the coronal fragment was achieved in nearly all coronal plane fractures.
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Use of small-fragment cortical lag screws maintained reduction in coronal plane fractures associated with supracondylar intercondylar distal femur fractures, according to recently published data.
“This study found the reduction of coronal plane fractures in supracondylar-intercondylar distal femur fractures are reliably maintained with small-fragment cortical lag screws oriented perpendicular to the fracture in the sagittal plane,” Jessica J. M. Telleria, MD, of the University of Washington Department of Orthopaedics and Sports Medicine, told Orthopedics Today. “The use of smaller implants minimizes the interference with the lateral implant necessary for the supracondylar component of the fracture.”
Reducing coronal plane fractures
Among 56 coronal plane fractures in 44 patients with supracondylar intercondylar distal femur fractures between January 2001 and November 2013, Telleria and her colleagues evaluated short-term radiographic outcomes. Sagittally oriented small-fragment cortical lag screws measuring 3.5 mm or smaller were used to stabilize the coronal plane fracture while a lateral periarticular plate was used to stabilize the supracondylar intercondylar component.
Results showed 75% of knees had open injuries. Overall, 98.2% of coronal plane fractures had radiographic union with no displacement of the coronal fragment while one knee developed avascular necrosis and required arthrodesis. Secondary procedures unrelated to the coronal plane fracture were required in 15 of 44 knees (34.1%).
“Given how prevalent nonunion and fracture subsidence are for the supracondylar component of these injuries, we expected to see a slightly higher failure rate for the coronal plane fragment fixation,” Telleria said. “The failure rate being extremely low demonstrates cortical lag screws, combined with a strict protected weight-bearing protocol, are sufficient to maintain reduction of the coronal fragment.”
Advancing treatment
According to Telleria, “looking at supracondylar intercondylar distal femur fractures as a whole and the management of nonunion and segmental bone loss remain challenging clinical problems.” She added research on bone grafting and biologic supplementation may decrease the incidence of nonunion and revision surgery.
Overall, Telleria and her colleagues hope current research will help advance fracture care.
“Management of distal femur coronal plane fractures with small-fragment cortical lag screws is fairly mainstream at many centers across the United States,” Telleria said. “However, there are still some domestic and international institutions where this is not common practice. It is [our] hope the present study will lend support to this technique and help to advance fracture care across all patient populations.” – by Casey Tingle
- Reference:
- Telleria JJM, et al. Orthopedics. 2016;doi:10.3928/01477447-20151222-13.
- For more information:
- Jessica J. M. Telleria, MD, can be reached at the Department of Orthopaedics and Sports Medicine at the University of Washington, Box 369798, 325 Ninth Ave., Seattle, WA 98104; email: telleria@uw.edu.
Disclosure: Telleria reports no relevant financial disclosures.