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5Reduction of the metaphysis/diaphysis

Usage of the external fixator/fimoral distractor

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.