Treatment of Nonunion in Femoral Supracondylar and Intercondylar Fracture

Lee, Duk Yong; Shim, Jae Ik; Kim, Taik Seon; Lee, Sung Jong; Lee, Suk Ha; Lee, Dong Ki; Yu, Yeon Sik; Lee, Eun No; Kim, Yoon Yeup

Abstract

The femoral supracondylar and intercondylar fractures are difficult to be treated due to severe soft tissue damage, comminution, intraarticular extension of fracture and injury to the quadriceps mechanism frequently. The causes of nonunion are inadequate anatomical reduction, fixation failure, bone defect and infection occasionally, which is difficult to be treated. The authors analyzed 16 cases with nonunion of femoral supracondylar and intercondylar fracture who had been treated surgicdlly from January 1990 to December 1991 According to AO/ASIF classification in the initial fracture patterns, type A were 8 cases, type B was 1 case and type C were 7 cases. The duration between initial treatment and surgical treatment of nonunion was 6 months in average. The causes of nonunion were fixation failure due to inadequate device selection in 9 cases, inadequate anatomical reduction or surgical technique in 4 cases and infection in 3 cases. The treatmentt were internal fixation with Dynamic condylar screw(DCS) in 9 cases, internal fixation with condylar blade plate in 4 cases, monofocal lenghtening with Ilizarov in 1 case and bifocal lenghtening with Ilizarov in 2 cases. According to Schatzker classification, the good result was obtained in 11 cases(68.8%). The complications were 3 knee joint ankyloses, 2 superficial wound infections, 1 delayed union and 1 deep vein thrombosis. In conclusion, the requirement for the good result in treatment of nonunion are exact anatomical reduction, rigid fixation and autogenous bone graft.