Internal fixation of supracondylar and bicondylar femoral fractures using a new semielastic device.

Previous reports of failures following surgery of distal femoral fractures prompted the development of a semielastic internal fixation device suitable for the mechanically weak bone of the elderly. The fixation device consists of intramedullary elastic Ender-type nails connected to cancellous screws at each condyle by a special coupling piece. Thus, the intercondylar fracture is rigidly stabilized by screws and adjusted to the supracondylar fracture by connected elastic nails. The device is easily applied through small incisions. During a two-year period 54 fractures of the distal third of the femur were treated. Most patients were elderly and suffered from concurrent diseases or previous ipsilateral fractures. The goal was twofold: to avoid traction in bed and to start early mobilization. Fifteen undisplaced fractures were treated by plaster or cast-brace. Five fractures were treated by traction. Thirty-four displaced supracondylar and bicondylar fractures were operated on using the new fixation device. No deep infections or osteomyelitis occurred. Immediate mobilization was possible in all 34 cases, most with an external support of plaster for two weeks and a hinged cast-brace for eight weeks. Twenty-nine patients were followed up to union; results in these displaced supracondylar and bicondylar femoral fractures were excellent in 12, good in nine, fair in five, and poor in three patients. The semielastic character of the system seemed to prevent the failures observed with the use of rigid internal fixation in osteoporotic bone.