Session V - Femur

Long-Term Functional Outcome of Operatively Treated Supracondylar Femur Fractures

Thomas Hupel, MD; Emil H. Schemitsch, MD, FRCS (C); Markku Nousiainen, BSc, MSc; Michael D. McKee, MD, FRCS (C); David J.G. Stephen, MD, FRCS (C); Hans J. Kreder, MD, FRCS (C); James P. Waddell, MD, FRCS (C), Saint Michael's Hospital, Toronto, ON, Canada

Purpose: The purpose of this investigation was to determine the long-term functional outcome of operatively managed supracondylar femur fractures.

Methods: Fifty-seven patients, with 57 operatively managed supracondylar femur fractures, were identified. In addition to demographic factors, the variables that were evaluated included the fracture type, type of osteosynthesis performed, and associated injuries. For each patient, pre- and all post- operative radiographs were analyzed for adequacy of reduction and time to union. Patients were contacted and administered functional outcome questionnaires to measure both global health status (SF-36) and disease specific status (WOMAC osteoarthritis index). Assessment scores were analyzed in relation to sex, age, presence of polytrauma, presence of open fracture, necessity for multiple operative procedures, and adequacy of operative reduction. The patient population consisted of 35 females and 22 males with a mean age of 52 years (range, 16 to 89 years). The average follow-up period was 5.2 years (range, 3 to 8.5 years).

Results: All fractures achieved union within an average time of 26.8 weeks. Thirty-two percent of the fractures required multiple procedures to achieve union. Time to union was significantly greater for open compared to closed fractures (average of 35 vs 17 weeks, p=0.02). Post-operative joint incongruity with a step or a gap was found in 26% of the fractures. The presence of joint incongruity was associated with a higher incidence of radiographic evidence of posttraumatic degenerative changes (p<0.01). The study population had a lower SF-36 aggregate physical component score (PCS) but a similar aggregate mental component score compared to the normative scores for the general population. There were no significant differences in the mean categorical scores except for the physical function domain for which the study population scored below the average for the general population (p<0.05). A multivariate analysis demonstrated that only the presence of an ipsilateral lower limb fracture was correlated to lower PCS (p=0.01). There was no correlation between the WOMAC scores and the perioperative variables studied.

Discussion/Conclusions: Operative management of supracondylar femur fractures results in satisfactory long-term functional results in all aspects of global health except physical function. Postoperative joint incongruity is associated with a higher risk of developing radiographic evidence of post- traumatic osteoarthritis of the knee. Patients with this injury have significant residual impairment in physical function and this disability is significantly greater in the presence of an ipsilateral lower limb fracture. Although postoperative joint incongruity is associated with a higher risk of developing radiographic evidence of posttraumatic osteoarthritis of the knee, there was no association with adverse functional outcome.