ORIF - lag screws
Indication summary: Large fragment, good bone quality, low demand patient
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.
- All displaced medial sagittal split fractures
- Patient not medically fit for surgery
- Direct articular surface reduction
- Early mobilization of the knee joint
- Lower incidence of osteoarthritis
- Risk of knee joint stiffness
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|