It is the rapid integration of the unreduced but well aligned vital fragments into the fracture callus, which buttresses the fracture area opposite the plate reducing the risk for overload and fatigue failure of the implant. Nature of comminution was guided by Winquist classification of femoral fractures dividing them into four grades of comminution. The preoperative planning involves determination of the approximate size of the plate required for fracture stabilizing assuming four holed purchase is required on the intact femur away from the fracture site. Here we shall discuss the operative technique for a supracondylar fractures. The patient is taken on a radiolucent table with arrangements to give traction to the limb and to control rotational alignment or the patient can also be put on a standard table with an assistant used to give traction and control the rotations.
Incision is taken on the condyle or trochanter.
Lateral approach is used. The incision is then placed close to the joint near the fracture so that it is possible to enter the dynamic condylar screw along with fixation of the intra articular extension of the fracture. The correct screw positioning is checked with radiographs. Once the screw position and length have been accepted, an incision is taken on the skin proximally near the comminuted fracture, so that an intact bridge of skin is maintained between the two incisions. The pre-operatively determined plate is selected and is reversed, so that the barrel faces out and then slipped under the vastus lateralis muscles close to the bone as possible.