Supracondylar Femoral Frx: Post Op Care

- See:
- Discussion:
    - consider 90 deg of flexion in splint for 4 days, then begin CPM;
    - need to start early motion;
    - look for late varus collapse of knee;
    - attempt to ambulate at 2-4 days, & consider FWB at 3-6 months;
    - delayed union: persistent instability 3-4 mo after injury;
          - more bone grafting may be necessary to salvage inadequate union;

- Accetable Alignment:
    - saggital alignment of less than 5 deg antecurvatum or less than 10 deg of retrocurvatum is acceptable;
    - frontal plane and rotational alignment of less than 5 deg is acceptable;

- Extension Contractures:
    - more common w/ non surgical treatment;
    - results from:
         - intra articular adhesions;
                - parapatellar adhesions;
                - obliteration of the lateral gutters;
                - obliteration of the suprapatellar pouch;
         - fibrosis of vastus intermedius that ties down rectus femoris to the anterior aspect of femur;
                - shortening of lateral and medial quad expansions;
                - shortening of rectus femoris;
    - treatment:
         - quadricepsplasty, will release in sequence all pathologic adehesions and will provide most pts with age ROM of 5-90 degs;
         - incision is made from a hands breadth below the trochanter to the knee joint, over the lateral side of the femur;
         - intrinsic release:
                - lateral capsulotomy;
                - removal of adehesions from the lateral gutters, supra-patellar pouch, and undersurface of the patella;
         - extrinsic release:
                - release of vastus lateralis from the linea aspera;
                - elevation of the vastus intermedius from the anterior femoral surface;
    - post op: 3-4 months of rehab is required before maximum flexion is reached

A technique for freeing the extensor apparatus in cases of stiffness of the knee. Juedet R, Judet J, Lagrange J. Mem Acad Chir. 1956;82:944-947.

The results of quadricepsplasty on knee motion following femoral fractures.

The Judet quadricepsplasty for management of severe posttraumatic extension contracture of the knee. A report of a bilateral case and review of the literature. 

Results of Judet Quadricepsplasty.

Quadriceplasty: the Judet technique and results in six cases.

Quadricepsplasty to improve knee function.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, May 29, 2012 3:34 pm