M.E.Müller: Atlas: Fracture 32-B1

Femur, Diaphysis,
wedge fracture, spiral wedge 2,20% of the total
3,64% of the femur
15,13% of the segment

373 fractures
31,2% group
58%M, 42%F

608 fractures
50,8% group
65%M, 35%F

215 fractures
18% group
56%M, 44%F

Subtrochanteric section Middle section Distal section

These are diaphyseal fractures with a spiral wedge third fragment that, once reduced, maintain contact between the proximal and distal fragments. The .1 subgroup indicates the subtrochanteric zone and the .2 subgroup corresponds to the middle zone of the diaphysis. Ref. Manual of Internal Fixation:
232 - 251. 254 - 265. 535 - 547.
Surgeon. JG, CS, RO.

We recommend anatomic reduction for both subgroups, applying interfragmentary compression between the third fragment and the proximal and distal fragments with lag screws as well as between the two main fragments with a DCPplate, which also has a protection (neutralization) effect.

The 95º condylar blade plate is the ideal implant for the subtrochanteric fractures since it adds some buttress effect to the biomechanical protection and tension band effects. For the middle zone diaphyseal fractures the

implant of choice is the 4.5mm straight femoral plate, prestressed through proper contouring.

It is advisable to add autologous cancellous bone grafting to the medial aspect of the femoral diaphysis. Bone grafting was performed in the illustrated 32-B1.1 case. In the illustrated 32-B1.2 case, bone grafting was not considered necessary because of the perfect reduction and compression obtained, and healing was by direct (primary) callus.

preoperative + 2 years

preoperative + 5 months

preoperative + 1 year + 1 year

preoperative preoperative + 0 months + 0 months

+ 2 months + 2 months + 1 years + 1 years

preoperative postoperative + 4 months + 4 years

These are diaphyseal fractures with the same characteristics as the previous page subgroups (32-B1.1 and 32-B1.2) but located in the distal third of the femur. Ref. Manual of Internal Fixation:
232 - 251. 254 - 265. 535 - 547.
Surgeon. JG, CS, RO.

The treatment principles are the same as for the proximal and middle third subgroups but both the reduction and the lag screw interfragmentary compression are especially difficult in the distal zone because of the thinner and more fragile cortex. It is usually advisable to add autologous cancellous bone graft.

The implant of choice is the 95º condylar blade plate or a 4.5mm straight plate contoured to the lateral femoral condyle. The straight plate is easier to contour accurately than the 95º condylar plate and, once provisionally fixed to the proximal fragment, allows indirect reduction of the fragments to the plate.

The fracture is first simplifyed by fixing the third fragment to the proximal fragment with a lag screw. The distal fragment is then reduced and fixed to the plate.

The use of the DCS has no biomechanical sense in these cases: the large sliding screw is designed to perform interfragmentary compression between the condyles (there is no intercondylar fracture in these cases) and the plate is unnecessarily thick. Furthermore, the barrel-plate angle junction may protrude subcutaneously in the lateral condyle and cause discomfort.

preoperative preoperative

postoperative postoperative + 4 months + 4 months

preoperative preoperative

postoperative postoperative + 11 months + 11 months




						Femur, Diaphysis, wedge fracture, spiral wedge	2,20% of the total 3,64% of the femur 15,13% of the segment






These are diaphyseal fractures with a spiral wedge third fragment that, once reduced, maintain contact between the proximal and distal fragments. The .1 subgroup indicates the subtrochanteric zone and the .2 subgroup corresponds to the middle zone of the diaphysis.		Ref. Manual of Internal Fixation: 232 - 251. 254 - 265. 535 - 547. Surgeon. JG, CS, RO.

We recommend anatomic reduction for both subgroups, applying interfragmentary compression between the third fragment and the proximal and distal fragments with lag screws as well as between the two main fragments with a DCPplate, which also has a protection (neutralization) effect. The 95º condylar blade plate is the ideal implant for the subtrochanteric fractures since it adds some buttress effect to the biomechanical protection and tension band effects. For the middle zone diaphyseal fractures the	implant of choice is the 4.5mm straight femoral plate, prestressed through proper contouring. It is advisable to add autologous cancellous bone grafting to the medial aspect of the femoral diaphysis. Bone grafting was performed in the illustrated 32-B1.1 case. In the illustrated 32-B1.2 case, bone grafting was not considered necessary because of the perfect reduction and compression obtained, and healing was by direct (primary) callus.






These are diaphyseal fractures with the same characteristics as the previous page subgroups (32-B1.1 and 32-B1.2) but located in the distal third of the femur.		Ref. Manual of Internal Fixation: 232 - 251. 254 - 265. 535 - 547. Surgeon. JG, CS, RO.

The treatment principles are the same as for the proximal and middle third subgroups but both the reduction and the lag screw interfragmentary compression are especially difficult in the distal zone because of the thinner and more fragile cortex. It is usually advisable to add autologous cancellous bone graft. The implant of choice is the 95º condylar blade plate or a 4.5mm straight plate contoured to the lateral femoral condyle. The straight plate is easier to contour accurately than the 95º condylar plate and, once provisionally fixed to the proximal fragment, allows indirect reduction of the fragments to the plate.	The fracture is first simplifyed by fixing the third fragment to the proximal fragment with a lag screw. The distal fragment is then reduced and fixed to the plate. The use of the DCS has no biomechanical sense in these cases: the large sliding screw is designed to perform interfragmentary compression between the condyles (there is no intercondylar fracture in these cases) and the plate is unnecessarily thick. Furthermore, the barrel-plate angle junction may protrude subcutaneously in the lateral condyle and cause discomfort.