There are, in general, two basic methods to reduce the
metaphyseal/diaphyseal component of a distal femur fracture when utilizing a
blade plate. The method utilized depends on the fracture morphology. In the
first method, the fracture of the metaphysis undergoes a direct reduction and
then the blade plate is subsequently inserted. This might be done in a single
plane short spiral or oblique fractures.
In the second method, the blade plate is inserted into the correct position in
the distal articular block of the femur. Then, after manual traction is used to
restore the appropriate length and rotation, the bone is drawn down to the
plate and the proximal screws are inserted. This type of reduction is very
helpful in highly comminuted metaphyseal/diaphyseal fractures.
Direct reduction instruments include:
- Large pointed reduction forceps
- Bone repositioning forceps
- Bone hook
Indirect reduction techniques are:
- Manual traction (illustrated)
- External fixator/distractor
Pitfall: osteoporotic bone
In osteoporotic bone indirect reduction techniques, using the angled blade
plate itself, may be preferable as attempts to reduce the fracture directly may
cause severe comminution. Attempts to apply reduction clamps to osteoporotic
bone will potentially crush the bone.