The key concept in fracture reduction when utilizing a DCS is that proper insertion in the distal femur allows the surgeon to use the plate to assist the reduction. The surgeon must control for length, rotation and sagittal plane deformity (hyperextension/hyperflexion). When performed in an open manner, length can be restored by manual traction. The sagittal plane deformity correction can be aided by a supracondylar bolster.
Closed reduction is aided by:
Complete anesthetic muscle relaxation of the patient
A bolster posterior to the supracondylar region to prevent hyperextension
Use of the femoral distractor, or external fixator
Colinear clamp (as illustrated)
In some circumstances it may not be possible to achieve a perfect anatomical reduction initially. Indeed, anatomical reduction of all fracture segments may not be desired except in simple extraarticular fractures. As long as the mechanical axis is restored this should be adequate in most situations.