Vol. 22, No. 11November 2000
Refereed Peer Review
FOCAL POINTKEY FACTS
Choosing appropriate orthopedicimplants and surgical techniquesis critical to the successfulmanagement of supracondylarfemoral (SCF) fractures in adultanimals.
Supracondylar FemoralFractures in Adult Animals
University of Tennessee
David A. Lidbetter, BVSc, MVS, CertSAS, MACVSc, MRCVS
University College Dublin
Mark R. Glyde, BVSc, MVS, MACVSc, MRCVS
Supracondylar femoral (SCF) fractures in adult animals present significantlygreater challenges to veterinary orthopedists than do fractures in immature animals in whichthe bone breaks are usually type I or II Salter-Harris physeal fractures. In adult animals, SCFfractures are often unstable because of their distal position and propensity to be comminuted.Because of the composition of the distal femur, minimal bone stock is usually available for im-plant placement. As a result, traditional implants such as intramedullary pins and dynamiccompression plates may not be adequate to stabilize fracture forces. A range of available im-plants offers additional approaches to the management of this relatively uncommon fracture.
emoral fractures are commonly repaired in small animals. Midshaft dia-physeal fractures are the most common femoral fractures, followed by frac-tures of the distal epiphyseum. Supracondylar femoral (SCF) fractures oc-cur infrequently in adult animals.
The major texts and veterinary scientificliterature cover the management of growth plate injuries in immature animalsand midshaft femoral fractures in adults in some detail; however, far less infor-mation is available on the management of the often more challenging distal frac-tures.
In humans, SCF fractures are a common fracture in which two distinctpatient populations exist: Younger people sustain these fractures as a result of high-velocity trauma, and elderly people with osteoporosis often sustain themafter minimal trauma.
Various orthopedic implants and techniques, includingintramedullary (IM) pinning, blade plating, buttress condylar plating, dynamiccompression plating, interlocking nailing, Zickel supracondylar nailing, anddouble plating, are employed in humans to repair the fractures.
Management of distal femoral fractures in young animals is typically straight-forward because of the simple nature of the fracture and the innate potential of young animals to heal rapidly. The fractures normally occur through the weak zone of hypertrophy in the physis; the surface of the fracture often interdigitatesin a
shape, giving the repair some inherent stability.
SCF fractures may be morechallenging surgically in adultdogs than in immature animalsin which the fracture tends tobe through the growth plate.
After the fracture is thoroughlyassessed, implants and surgicaltechniques should be tailored toindividual fracture configurations.
Traditional repair methods suchas intramedullary pinning andstandard bone plating may notprovide ideal stability for SCFfractures.
Alternative devices should beconsidered to stabilize SCFfractures in adult animals.