Distal femur Partial articular fracture, medial condyle, sagittal simple

Closed reduction internal fixation (CRIF); lag screws

MIO - lag screws

Indication summary: Large fragment, good bone quality, low demand patient

Skill: Highly experienced and skilled surgeon
Equipment: Simple surgical and imaging resources

If the fracture is completely undisplaced, or minimally displaced, closed reduction internal fixation techniques are often appropriate through minimal incisions. Displaced fractures are often difficult to reduce, due to interposed soft tissue, or organizing fracture hematoma. It is easier to perform closed reduction internal fixation techniques within the first 24-48 hours after injury, before the fracture hematoma begins to organize.

Displaced fractures should be fixed with lag screws. Unfixable, small fracture fragments may need to be excised or washed out of the knee joint.

In minimally displaced fractures reduction may be checked arthroscopically. Standard lag screws are inserted under image intensifier guidance.

Indication

  • Minimally displaced medial sagittal split fractures

Contraindications

  • Patient not medically fit for surgery
  • Displaced fractures
  • Lack of arthroscopic experience

Advantages

  • Indirect articular surface reduction
  • Minimally invasive approach
  • Early mobilization of the knee joint
  • Lower risk of secondary osteoarthritis

Disadvantages

  • Imperfect reduction
  • Technically demanding

Legend

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

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v1.0 2008-12-03