Name of the Procedure:

Open Treatment of Femoral Supracondylar or Transcondylar Fracture with Intercondylar Extension (includes internal fixation)

Summary

This surgical procedure involves the open reduction (re-alignment) and internal fixation (securing with hardware such as plates, screws, or rods) of a fracture located above or through the condyles of the femur (thigh bone) where the fracture extends into the area where the femur meets the knee. It's a delicate procedure aimed at restoring bone alignment and knee function.

Purpose

The procedure addresses fractures of the distal femur that extend into the knee joint, which can be complex and challenging to treat. The goals are to properly align and stabilize the bone, allow for appropriate healing, and restore as much function and mobility to the knee as possible.

Indications

• Severe fractures of the distal femur where the fracture line extends into the knee joint (intercondylar extension).
• Patients unable to heal properly with non-surgical methods due to the severity or complexity of the fracture.
• Open fractures or those involving significant bone displacement.
• Patients experiencing instability, severe pain, or impaired function due to the fracture.

Preparation

• Patients may need to fast for several hours before surgery.
• Adjustments in medication might be necessary, especially blood thinners.
• Preoperative imaging studies such as X-rays, CT scans, or MRI to assess the fracture.
• Blood tests and a physical examination to ensure the patient is fit for surgery.

Procedure Description

1. Anesthesia: The patient is given general or spinal anesthesia.
2. Incision: A surgical incision is made above the knee to expose the fracture.
3. Reduction: The fractured bone segments are re-aligned to their normal positions.
4. Fixation: Internal fixation devices such as screws, plates, or rods are used to secure the bones.
5. Closure: The surgical site is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes between 2 to 3 hours, depending on the complexity of the fracture.

Setting

The surgery is performed in a hospital operating room equipped for orthopedic surgery.

Personnel

• Orthopedic Surgeon: Conducts the procedure.
• Surgical Nurses: Assist the surgeon and provide perioperative care.
• Anesthesiologist: Manages anesthesia and monitors patient vitals.
• Radiologic Technologist: May assist with imaging during surgery.

Risks and Complications

• Common Risks: Infection, bleeding, blood clots, and pain at the surgical site.
• Rare Complications: Nerve or blood vessel damage, hardware issues (e.g., migration or loosening), nonunion (bone not healing), and stiffness or decreased range of motion in the knee.

Benefits

The primary benefit is the restoration of proper bone alignment and stability, which allows for natural healing and the return of knee function. Most patients can expect to regain significant mobility and experience reduced pain within a few months post-surgery.

Recovery

• Post-Procedure Care: Pain management with medications, wound care, and physical therapy to regain strength and mobility.
• Recovery Time: Generally, 6 to 12 weeks, but full recovery and return to activities can take several months.
• Restrictions: Limited weight-bearing on the affected leg initially, gradual return to activities as prescribed by the surgeon.
• Follow-Up: Regular follow-up appointments to monitor healing and progress.

Alternatives

• Non-surgical Treatment: Casting, bracing, or traction; usually only effective for less severe fractures.
• Minimally Invasive Surgery: Sometimes an option depending on the fracture type, but not typically for complex intercondylar extensions.
• Pros and Cons: Non-surgical methods have fewer immediate risks but may not heal complex fractures correctly. Minimally invasive options have quicker recovery but may not be suitable for all cases.

Patient Experience

During the procedure, patients under general anesthesia will be asleep and feel nothing, while those under spinal anesthesia will be awake but numb from the waist down. Post-surgery, pain and swelling are common, managed with medications. Patients may feel discomfort during initial physical therapy but will see gradual improvement in movement and strength.