الفهرس 
Anatomy of the distal femurOnly 14 pages are availabe for public view
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Abstract
Our study included thirty distal femoral fractures in twenty nine patients.
The aim of this study was to assess the functional and anatomical end results achieved in this group of patients treated by Green-Seligson-Henry (GSH) supracondylar intramedullary nail.
The age of the patients ranged between sixteen and seventy five years with an average 48.5 years. This series included 16 males and 13 females. There were 14 patients with significant associated diseases.
High velocity injuries were the cause in 17 patients, mostly affecting younger age group, while low velocity injury was the cause in 12 patients mostly in elderly age group. Twelve patients had associated injuries.
Twenty nine fractures were classified according to the AO/OTA classification; 21 type A fractures, and 8 type C fractures. There was one periprosthetic fracture proximal to total knee replacement. Five fractures were open; two grade I, and three grade II according to Gustillo and Anderson classification. There were 2 pathological fractures.
Nailing was done after an average of 5.5 days from the injury. Percutaneous transpatellar approach was used in twenty two fractures, medial parapatellar approach in six fractures, while combined transpatellar and limited posterolateral approach to the distal femur was used in two fractures. Bone graft was used in only one patient.
Postoperative rehabilitation depended upon the surgical stabilization with supracondylar nail and other supplement screw fixation. In twenty five fractures, continuous passive motion (CPM) program was started within 48 hours postoperatively. Unrestricted weight bearing was permitted after clinical and radiological union (average three months).
The follow-up period ranged from 12 to 30 months with an average of 21 months. Twenty nine fractures progressed to union in an average time of 14 weeks. The average range of knee flexion was 113o, while the average extension lag was 2.5o. Fourteen patients had full range of knee motion and all patients except one had 90o or more of knee flexion.
Complications included; four cases with malalignment; two with valgus deformity 9o, one with combined 7o valgus and 1.5 cm shortening, and one with 2 cm shortening. Other complications included deep infection in one case, iatrogenic fracture of femoral shaft in another case, two cases of nail impingement and subsequent knee pain, and one case with loose distal screw.
According to Neer’s criteria, the final functional outcome was excellent in nine fractures, satisfactory in fifteen fractures, unsatisfactory in five fractures, and one failure.
In conclusion; results of this study suggested that, the supracondylar nail is an effective method for type A, most of type C distal femoral fractures, and in selected cases with a periprosthetic fracture. It provides rigid fixation through a limited incision, in a region of the femur where a widening canal, thin cortices, and occasionally poor bone stock make fixation difficult. It can be used successfully in adult patients of different age groups to achieve a high rate of fracture union.
Most of the complications were due to technical errors which should be avoided with meticulous technique and experience i.e. the correct choice of nail insertion site is mandatory to restore the anatomical alignment, the nail should be seated below the cartilage surface, distal screws with locking bolts should be used in osteoporotic bone, and finally, the knee joint should be thoroughly irrigated before wound closure.