A novel approach to distal femur: a minimally invasive technique for supracondylar and intercondylar fracture.

Abstract

For treating distal femur fractures, minimally invasive plating techniques with indirect reduction of the metadiaphysis while minimizing the damage to the peripheral soft tissue has gradually become the standard. However, all the current approaches use a straight or lazy curved incision adjacent to the patella or along the lateral side of the femur, which allows for easier proximal extension but increases the incision length. In order to achieve a more physiological and esthetic outcome while leaving the metadiaphysis untouched, we developed an approach using a lambda-shaped incision, which sacrifices the potential for proximal extension but preserves much more peripheral soft tissue. Here, we describe our technique and our experience with it in 19 patients (12 men and 7 women). Fractures healing by first intention was observed in all patients. The postoperative knee range of motion can reach up to 90° in most of the patient. Clinically, 9 patients had excellent results, 6 had good results, 3 had fair results, and 2 had loss of follow-up. Our minimally invasive lambda-incision approach allows sufficient visual access to almost the entire joint surface, including the entire lateral femoral condyle, trochlear surface, and distal medial condyle, where reduction is required. The lambda incision provides a much larger window than that offered by a same-length straight incision. The vertical turn at the mid-patellar level parallels the skin crease and geniculate artery, reducing soft tissue damage and resulting in a smooth healing wound. Moreover, plate and distal screw insertion is easier than that through a straight incision. Because the metadiaphysis region is mostly left untouched, ideal fracture-healing environment is preserved.