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5Reduction of the metaphysis/diaphysis

Reduction of the metaphysis

Reduction of metaphyseal component

The key concept in reduction of the metaphyseal component of the fracture when using a Condylar LCP is that proper application of the Condylar LCP on the distal femur allows the surgeon to use the plate to achieve the metaphyseal fracture reduction. When brought down to the proximal femoral shaft, the correct frontal plane alignment has been assured. The surgeon must then control length, rotation, and sagittal plane deformity (hyperextension/hyperflexion). When performed in an open manner, length can be aided by manual traction. The sagittal plane deformity correction can be aided by supracondylar bolsters.

Reduction aids
Open reduction is aided by:

  • Bolsters posterior to the supracondylar region, which help correct the hyperextension deformity of the distal femoral articular block.
  • Manual traction which helps restore length of the limb.
  • Direct pointed reduction forceps placement (particularly helpful in spiral fractures of the metaphysis).
  • A Hohmann retractor, which may be used as a lever to correct translational displacement.
  • The plate itself; by applying the plate in the correct position on the distal femur, appropriate alignment is established when the plate is fixed to the proximal femur.