MANUAL MINORS
A supracondylar fracture is a fracture that occurs in the distal part of the femur, just above the femoral condyles, near the knee. It is more common in older adults with osteoporosis or as a result of high-energy trauma in younger individuals.
These fractures can be intra-articular or extra-articular and pose a challenge in management due to their proximity to the knee and the need to restore proper alignment to preserve joint function.
Diagnosis
The diagnosis is made after trauma to the distal femur, with the patient presenting with severe pain, inability to move the knee, and visible deformity of the limb. On physical examination, there may be swelling, leg shortening, and displacement of the knee joint.
X-rays of the femur and knee confirm the fracture, and a computed tomography (CT) scan is commonly performed to better assess the fracture pattern, especially if it involves the joint surface.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Femoral Shaft Fracture | Occurs more proximally, in the femoral shaft, without involvement near the knee. |
Tibial Plateau Fracture | Affects the upper part of the tibia, involving the knee joint. |
Knee Dislocation | Displacement of the knee bones without visible bone fracture. |
Cruciate Ligament Injury | Joint instability, but without visible fractures on imaging. |
Patellar Fracture | Affects the patella, without directly involving the femur or femoral condyles. |
Emergency Management
Initial emergency management includes immobilising the affected limb with splints or immobilisation devices, providing analgesia (NSAIDs or opioids), and stabilising the patient if they have sustained high-energy trauma.
Temporary traction may be used to reduce pain and displacement in severe cases. It is essential to assess vascular and neurological status, as nearby major vascular structures may be compromised in displaced fractures.
Definitive Treatment
Definitive treatment is usually surgical, with the decision depending on the fracture pattern and displacement. Treatment options include:
Internal fixation with plates and screws: Used for most displaced or complex fractures.
Retrograde intramedullary nailing: An option for extra-articular fractures or those with minimal joint involvement.
Traction and conservative management: Considered only for non-displaced fractures or in patients with high surgical risk.
The goal of surgery is to restore the anatomical alignment of the knee and allow for early mobilisation to prevent stiffness. Following surgery, the patient begins physiotherapy to regain knee mobility and strengthen the thigh muscles. Weight-bearing on the affected limb may initially be restricted, and follow-up X-rays are required to ensure proper healing.
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