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5Reduction of the metaphysis/diaphysis

Alternative: external fixator/femoral distractor

Some surgeons find it useful to use an external fixator (or femoral distractor) from the proximal femur to the proximal tibia.

Due to the pull of the gastrocnemius muscle, the distal fragment has a tendency to be displaced into extension at the metaphyseal fracture area, when distraction is applied.

To avoid this, the knee is brought into full extension, and the distal femoral fragment is stabilized in this position to the tibia using a temporary cerclage wire around a Schanz screw inserted in the distal femoral articular block.

Insert the proximal and distal fixator (distractor) pins carefully in order not to conflict with the later plating procedure. Safe positions would be anterolateral or anterior on the femur.