This document describes the surgical technique for fixing an intraarticular distal femur fracture using a fixed angle plate. Key steps include using a lateral incision to reduce the fracture and place lag screws, inserting a bolster to maintain reduction, placing a fixed angle plate subperiosteally, and inserting screws through a percutaneous incision to secure the plate. Post-operative x-rays show anatomic alignment of the joint surface and metaphysis.

2. AP view of a comminuted C3 intraarticular distal femur fracture.

3. Lateral view demonstrating the typical extension deformity caused
by the pull of the origin of the gastrocnemius muscles from the
posterior distal femur.

4. These figures demonstrate the intracondylar extension of the fracture
and a free intercondylar fragment (arrows).

6. FEMORAL AXIS
PLANNED SCREW
POSITIONS
When planning for the lag screw fixation, the surgeon must leave room
for the lag screw of the fixed angle device or intramedullary nail.

7. A 7-10cm lateral parapatellar incision is made which can be extended
proximally into a formal lateral approach to the femur if necessary. The
intercondylar reduction is performed through this limited arthrotomy.

8. Periarticular or standard clamps are used to manipulate and
reduce the fracture which is stabilized with the templated 6.5 mm
lag screws with washers. The screws are placed anterior and
posterior to the planned position of the fixed angle device.

9. Note the anatomic reduction of the articular surface. At this point, the
articular surface is reconstructed and the metaphyseal component of
the fracture is still unfixed.

10. AP VIEW
LATERAL VIEW

11. AP VIEW
LATERAL VIEW
AP and lateral radiograph demonstrating the position of the lag screw
as templated. Note that with traction, both the AP and lateral
radiographs are manipulated such that the metaphysis is reduced.

12. AP VIEW
LATERAL VIEW
This requires a bolster underneath the metaphyseal fracture and some
flexion of the knee to correct the extension deformity of the quadriceps.
The dotted line represents the axis of the femur where the plate will be
placed.

13. 95°
AP radiograph demonstrating the angle at which the guidewire for
the fixed angle lag screw should be placed. It should be parallel
with the distal femoral articular surface, which is at approximately
95o to 98o from the femoral shaft.

14. After the lag screw is placed, the appropriate sized fixed angle
plate is slid subperiosteally up the femur. Notice the bolster,
which is supporting the fracture in a reduced position.

15. After the plate is advanced subperiosteally up the
femur, the distal fragment is manipulated such that
the plating engages the lag screw.

16. After the plate is advanced subperiosteally up the
femur, the distal fragment is manipulated such that
the plating engages the lag screw.

17. AP VIEW LATERAL VIEW
AP and lateral radiographs demonstrating that the plate is against
the femur and the metaphysis is generally reduced.

18. The lateral radiograph can be used in a similar fashion to a
perfect circle technique used in nailing to place the proximal
screws percutaneously.

19. A percutaneous incision is used to allow for the placement of three
screws through this incision. This image demonstrates the drill
being introduced percutaneously into the hole and drilling through
the plate into the femur.

20. The first screw is the most proximal to seat the plate.

21. As the most proximal screw is placed, it pulls the
femoral shaft against the plate.

22. As the most proximal screw is placed, it pulls the
femoral shaft against the plate.

23. As additional screws are placed, better fixation
of the proximal fragment is obtained.

24. The final radiograph demonstrating the parapatellar incision
for reduction of the joint and the percutaneous incisions
utilized for the placement of the screws.

25. The size of the plate held up against the leg after fixation.

26. Immediate postoperative AP radiograph

27. Lateral radiograph immediately postoperative, demonstrating
anatomic alignment of the metaphyseal region, as well as the
joint.

28. AP VIEW
LATERAL VIEW
AP and lateral radiographs demonstrating
early callus formation at six weeks.