The records on fifty-two supracondylar-intercondylar fractures of the
femur were reviewed twenty to 120 months after injury. More than one-third
of the fractures had been open. All of the fractures were treated in a
single trauma center, using: (1) a single lateral incision, (2) internal
fixation with ASIF interfragmentary screws and plates, (3) bone-grafting of
comminuted metaphyseal segments, (4) impaction of comminuted metaphyseal
segments in osteoporotic elderly patients, and (5) repair of any associated
torn ligaments and patellar fractures. Postoperatively, early active motion
of the knee was encouraged, and for selected patients a brace was used only
to protect the repair of associated disruptions of ligaments or of the
extensor mechanism. The fractures were classified by the ASIF system, with
C1 being a simple Y pattern, C2 having additional supracondylar
comminution, and C3 having intra-articular comminution. The final results
were rated using the system that was described by Neer et al. for fractures
of the distal end of the femur. The average time between the operation and
full weight-bearing (healing) was 13.6 weeks and ranged from 12.3 weeks for
C1 fractures (as graded using the ASIF classification) to 15.4 weeks for C3
fractures. The average final arc of motion of the knee was 107 degrees,
ranging from 113 degrees for C1 fractures to 99 degrees for C3 fractures.
C1 fractures had a better outcome (92 per cent excellent and good results)
than did C2 and C3 fractures (77 per cent excellent and good results). Two
amputations and one arthrodesis were done to treat infection, and infection
accounted for three of the four poor results. Age did not influence the
final results, although elderly patients had a longer period of
hospitalization. Supracondylar-intercondylar fractures of the femur should
be analyzed separately from other fractures of the distal end of the femur
because of their intra-articular involvement and associated ligamentous
injuries and patellar fractures. Rigid internal fixation permits early
functional rehabilitation of the patient and decreases the incidence of
malunion, non-union, and loss of fixation.