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