Intraoperative Assessment of Coronal Alignment in Distal Femur Fracture Fixation: Technical Trick

Abstract

Summary: Supracondylar femur fractures represent a challenging and common injury treated by many orthopedic surgeons. An array of surgical fixation options has been developed to help the treating surgeon restore normal anatomic alignment of these fractures, and lateral precontoured condylar femoral locking plates have become a common implant for most surgeons in treating these fractures. Although these precontoured plates provide significant benefit to the treating physician in regards to gaining appropriate bony fixation, common technical errors that may lead to malalignment when using these plates have been described. Avoiding these errors will help improve patient outcomes. Here, we describe a novel, inexpensive, and universally available technique that may aid the treating surgeon in restoring coronal alignment when treating distal femur fractures.

How does intraoperative fracture malalignment affect postoperative function and bone healing following distal femoral fracture?

“…Although we believe this is an effective method for this study design, in actual clinical practice, intraoperative evaluation methods are important, and we were unable to make any recommendations regarding this issue. Scott et al 30 proposed an effective intraoperative assessment of coronal alignment using the anatomical lateral distal femoral angle of the contralateral distal femur view.…”

External Fixator–Assisted Reduction of Distal Femur Fractures: A Technical Trick

“…Mechanical malalignment in distal femur fractures continues to be an issue during lateral distal femoral locking plate application, thereby hindering bony union. 5,10,16 Coronal plane malreductions consisting of valgus and translational ("golf club") components are an issue when using the lateral distal femur locking plate. Several methods have been described to control coronal plane reduction including meticulous interpretation of radiographic imaging, intraoperative fluoroscopic imaging of the contralateral limb for comparison, using the opaque electrocautery cord to evaluate coronal alignment, and matching an outline of the anteroposterior view of the contralateral distal femur on the fluoroscopic image intensifier.…”

“…Several methods have been described to control coronal plane reduction including meticulous interpretation of radiographic imaging, intraoperative fluoroscopic imaging of the contralateral limb for comparison, using the opaque electrocautery cord to evaluate coronal alignment, and matching an outline of the anteroposterior view of the contralateral distal femur on the fluoroscopic image intensifier. 5,16,17 In addition, distal femoral locking plates are designed to help restore the mechanical axis by placing reference wires or screws at a fixed angle in the condylar portion of the plate parallel to the distal femoral articular surface.…”