Internal fixation for supracondylar fractures of the femur in the elderly patient.

Supracondylar fractures of the femur may present difficult problems in their management at any age. These problems are frequently compounded when the fracture occurs in an elderly person. Treatment may involve plaster fixation or necessitate prolonged immobilisation of the leg on a Thomas’s splint, so occupying an acute hospital bed for many weeks. Such treatment is likely to be followed by stiffness of the knee, especially when arthritic changes are already present in the joint. Union is by no means assured with conservative treatment, and non-union is disastrous, both socially and surgically, in this age group. Internal fixation has not achieved wide acceptance, largely perhaps for technical reasons. Neer, Grantham and Shelton (1967) reported only 52 per cent of satisfactory results in twenty-nine patients treated by internal fixation. Stewart, Sisk and Wallace (1966) reviewed sixty-nine patients and found that although 54 per cent of their patients had excellent or good results, 46 per cent were fair or poor. Included in this series were ten patients with non-union and ten with delayed union. All these workers felt that supracondylar fractures of the femur were generally unsuitable for internal fixation, and in many of their patients internal fixation was unable to stabilise the fracture without the addition ofsome other form ofexternal support. It is our contention that the poor results of internal fixation are due essentially to the