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04 Aug 2025
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Supracondylar Femur Fracture with Simple Intercondylar Split in an Obese Elderly Female.

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Clinical Details

Clinical and radiological findings:  A 68-year-old obese female sustained a fall from a step stool, resulting in a supracondylar femur fracture with a simple intercondylar split. CT imaging confirmed the absence of comminution and no involvement of Hoffa fragments. The initial radiological assessment indicated a closed injury with no neurovascular compromise.

Preoperative Plan

Planning remarks:  The preoperative plan involved percutaneous reduction and fixation of the intercondylar split using a quad clamp and lag screws. The metaphyseal component was to be addressed with closed retrograde intramedullary nailing after achieving appropriate length, alignment, and rotation through skeletal traction and percutaneous reduction techniques.

Surgical Discussion

Patient positioning:  Supine position on a radiolucent table, allowing for fluoroscopic guidance during the procedure.

Anatomical surgical approach:  Percutaneous approach for the intercondylar split, utilizing a quad clamp for reduction. Lag screws were placed percutaneously to achieve compression. For the metaphyseal fracture, a closed retrograde intramedullary nailing technique was employed, respecting the fracture biology and minimizing soft tissue disruption.

Operative remarks: 

The surgeon emphasized the importance of early weight-bearing in elderly patients to facilitate return to function. The choice of retrograde intramedullary nailing was favored for its ability to provide stable fixation while allowing immediate progressive weight-bearing. The procedure respected the biological environment of the fracture, promoting optimal healing conditions.

Postoperative protocol:   Immediate progressive weight-bearing was initiated postoperatively, with the patient using walker assistance. By four weeks post-surgery, the patient was bearing full weight.

Follow up:   Not specified.

Orthopaedic implants used:   Percutaneous quad clamp, lag screws, retrograde intramedullary nail.

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