Distal femur Partial articular fracture, medial condyle, sagittal simple

Open reduction internal fixation (ORIF); lag screws

ORIF - lag screws

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

Skill: Some specialized surgical experience
Equipment: Full specialized surgical and imaging resources

Displaced fractures are often difficult to reduce by closed methods, due to interposed soft tissue, or organizing fracture hematoma. After 48 hours it may well be easier to perform an open approach as it may be impossible to maintain an anatomical reduction by closed means.

It will be regarded that arthroscopically assisted reduction of distal femoral fractures constitutes an open reduction technique, because of opening of the joint and use of arthroscopic instruments.

Displaced fractures should be fixed with lag screws.

In poor bone stock, or more vertical fracture planes a buttress plate is added to enhance stability.

Indication

  • All displaced medial sagittal split fractures

Contraindication

  • Patient not medically fit for surgery

Advantages

  • Direct articular surface reduction
  • Early mobilization of the knee joint
  • Lower incidence of osteoarthritis

Disadvantage

  • Risk of knee joint stiffness

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