ORIF

Definition

Coronal plane fracture of distal femoral condyle

- intra-articular

- often only attachment is posterior capsule

Epidemiology

Rare

Mechanism

Usually a severe valgus trauma

Xray

AO Classification

Types

1. Supracondylar

2. Unicondylar

3. Intracondylar

Xrays

Supracondylar / Extra-condylar

Indications

< 60 with good bone stock and preserved joint space

Reduction

Union rates increased with anatomical reduction

Options

- closed reduction

- open reduction / if closed reduction fails

Accept

- no varus

- < 15^o valgus

- < 10^o AP plane

Definition

Garden 1 / 2

Algorithm

ORIF

- ~ 15% displacement rate with non operative management

- increased risk of non union

- reduced hospital in patient stays

Options

Cannulated screws

DHS + derotation screw

3 cannulated screws

1.  Anterior process

Part of complex sprain / easily missed

- non operative if small

- ORIF if large and displaced

2.  Tuberosity fractures

Need ORIF if displaced

- have T Achilles attached and can put skin under threat

- ORIF (usually closed reduction and screw)

Operative v Nonoperative Literature

1.  Buckley etal JBJS Am 2002

Prospective multi-centred RCT

- 309 displaced intra-articular fractures

- operative v non operative management

- 2 year follow up

Findings

- used patient orientated functional outcomes

- overall VAS and SF36 not significantly different between 2 groups

Improved Operative Outcome if

- not workers compensation

- women

- < 29

Epidemiology

Most common long bone fracture

Aetiology

Young patients / sports

Elderly / simple falls

MVA - often compound

Tscherne Soft Tissue Classification

Grade 0

- nil ST injury

Grade 1

Epidemiology

Young men

Aetiology

FOOSH

- axial load, dorsiflexion and radial deviation

DISI occurs in ulna deviation

Herbert Classification

Type A    Stable acute fracture

A1 Tubercle

Epidemiology

2 groups

1.  Elderly

- low velocity injury

- osteoporotic

- need to start bisphosphonates

2.  Young patients

- high velocity injury

Anatomy

Distal Radius Angles

- radial volar tilt 11°

- radial inclination  22°

- radius is 11 mm longer than ulna 

- ulna variance 2mm positive on average

Glenoid Fractures

Indications for Surgery

ORIF

- > 5mm step

- > 1/4 glenoid rim and displaced

Ideberg Classification Intra Articular Fracture

Type I

Fractures of the Glenoid rim

I A anterior 

I B posterior

Differentiate from small bony Bankart