الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Fractures of the supracondylar femur posed considerable therapeutic challenges throughout the history of fracture treatment. Anatomic reduction, stabilization, early weight bearing and short hospital stay are the major goals of fracture management. Operative treatment has become a standardized procedure and now it is recommended worldwide.
Rigid internal fixation of supracondylar femur fractures promotes rehabilitation of the patient and functional restoration of the limb, particularly when multiple injuries are present. One of the most common types of internal fixation for the supracondylar femur fracture is the retrograde nail.
Supracondylar nailing has its greatest advantage over other forms of fixation in those patients who are multiply or critically injured. I.M. nailing offers potential biomechanical advantages because their intramedullary position results in less stress on the implant, they have the potential for load sharing and they can be inserted with minimal soft tissue stripping. The use of antegrade nail in supracondylar fractures has been associated with angular deformities because of the inability of the distal interlock of the antegrade nail to achieve control of the small and often osteoprotic distal fracture fragment with high incidence of metal failure.
The intramedullary position of the retrograde interlocking naildecreases the lever arm, reducing the varus or valgus angulationBlood loss is minimized by the ability to use tourniquet control.
There are potential disadvantages of the supracondylar nail, including knee sepsis, stiffness, and patellofemoral degeneration. One
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could postulate that the hollow nail might act as a conduit for infection to pass into the knee joint from an infected fracture site.
Infection did not occur in the present series, perhaps because an aggressive approach was taken towards anti – septic measures and the minimal soft tissue dissection. Stiffness of the knee was minimized by aggressive physical therapy and by positioning the nail and interlocking screws appropriately.
Care was taken to avoid inserting interlocking screws that were too long distally because impingement on the soft tissues can result in difficulty moving the knee.
The nail was always seated deep to the articular surfaces near the intercondylar notch to prevent impingement upon the patella during knee flexion.
Fatigue fracture of the supracondylar nail was a significant problem prior to the design changes which increased available nail diameters to 12 and 13 mm, and decreased the interlocking screw diameter to 5.0 mm.None of the nails with the new design failed.
Knee function at final review was very good, with no evidence of significant iatrogenic injury from the technique of retrograde insertion of the nail. Subjectively patients were satisfied, with no one complaining of more than occasional knee discomfort. Range of motion of the knee averaged 120 degrees of flexion (90- 140) with no patient demonstrating a more than 5 degrees flexion contracture.