Alternative: external fixator/femoral distractor
Some surgeons find it helpful to use an external fixator (or femoral
distractor) spanning from the proximal femur to the proximal tibia.
Due to the pull of the gastrocnemius muscle, the distal femoral articular
block 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 in the distal femur and an external fixator
pin in the proximal tibia.
Insert the proximal and distal fixator pins carefully, in order not to
conflict with the later plating procedure. For this reason, safe positions
would be anterolateral, or anterior, on the femur.