M.E.Müller: Atlas: Fracture 32-B2

Femur, Diaphysis,
wedge fracture, bending wedge 1,59% of the total
2,63% of the femur
10,93% of the segment

133 fractures
15,4% group
73%M, 27%F

614 fractures
71,1% group
74%M, 26%F

117 fractures
13,5% group
71%M, 29%F

Subtrochanteric section Middle section Distal section

These are subtrochanteric fractures with a bending (flexion) wedge third fragment that, once reduced, maintain contact between the proximal and distal fragments. Ref. Manual of Internal Fixation:
535 - 547. 254- 265.
Surgeon. CS.

This is an ideal indication for the 95º condylar blade-plate. Preoperative planning over tracing paper drawings is essential. The fracture is first provisionally reduced with clamps, the blade of the plate is introduced accurately and the most proximal screw is inserted. The fragments are then reduced to the plate. The third fragment is fixed to the distal fragment with a lag screw and axial compression is then applied to the assembly, either with the tension device or with the DCP holes.

Another technical option is to first simplify the fracture by reducing and fixing the third fragment. This is followed by the introduction of the blade and the fracture is then reduced to the plate.

The most difficult step of the technique is the precise placement of blade and the drilling of the calcar screw hole with a 3.5mm drill bit, that must be performed carefully and slowly in order for it to bite into the hard and arched medial cortex. If the drilling is done too fast, the tip of the drill will slide proximally along the inner surface of the calcar and the drill bit will break.

preoperative preoperative

postoperative postoperative

+ 6 months + 6 months

These are diaphyseal fractures with a bending (flexion) wedge third fragment that, once reduced, maintain contact between the proximal and distal fragments. The subgroup .2 corresponds to the middle zone and the .3 to the distal zone of the femoral diaphysis. Ref. Manual of Internal Fixation:
535 - 547. 266 - 269. 291 - 331.
Surgeon. Q de LL, RO.

The middle third fractures can be treated either with a plate or by intramedullary nailing. If a plate is to be used, it is mandatory to obtain anatomic reduction as well as the perfect application of the interfragmentary and axial compression techniques and the addition of cancellous bone graft. It is because of these reasons, seen as difficulties by some people, that many have switched to the interlocked nailing and prefer not to bother with the reduction of the third fragment. Healing is then obtained by a voluminous callus that includes the third fragment.

For the fractures of the distal third, where the medullary canal flares and the cortex is thinner, we prefer anatomic reduction and internal fixation with the condylar blade plate or with a contoured straight plate. In this zone, the intramedullary nail by itself cannot tutor the axial loads nor neutralize the bending and torsional loads; the nail only acts as a buttress for the two distal screws that receive all these loads and may suffer failure breakage.

preoperative postoperative

+ 4 months + 8 months

preoperative 0 months + 6 months

+ 11 months + 11 months + 19 months

preoperative + 8 months + 8 months




						Femur, Diaphysis, wedge fracture, bending wedge	1,59% of the total 2,63% of the femur 10,93% of the segment






These are subtrochanteric fractures with a bending (flexion) wedge third fragment that, once reduced, maintain contact between the proximal and distal fragments.		Ref. Manual of Internal Fixation: 535 - 547. 254- 265. Surgeon. CS.

This is an ideal indication for the 95º condylar blade-plate. Preoperative planning over tracing paper drawings is essential. The fracture is first provisionally reduced with clamps, the blade of the plate is introduced accurately and the most proximal screw is inserted. The fragments are then reduced to the plate. The third fragment is fixed to the distal fragment with a lag screw and axial compression is then applied to the assembly, either with the tension device or with the DCP holes.	Another technical option is to first simplify the fracture by reducing and fixing the third fragment. This is followed by the introduction of the blade and the fracture is then reduced to the plate. The most difficult step of the technique is the precise placement of blade and the drilling of the calcar screw hole with a 3.5mm drill bit, that must be performed carefully and slowly in order for it to bite into the hard and arched medial cortex. If the drilling is done too fast, the tip of the drill will slide proximally along the inner surface of the calcar and the drill bit will break.






These are diaphyseal fractures with a bending (flexion) wedge third fragment that, once reduced, maintain contact between the proximal and distal fragments. The subgroup .2 corresponds to the middle zone and the .3 to the distal zone of the femoral diaphysis.		Ref. Manual of Internal Fixation: 535 - 547. 266 - 269. 291 - 331. Surgeon. Q de LL, RO.

The middle third fractures can be treated either with a plate or by intramedullary nailing. If a plate is to be used, it is mandatory to obtain anatomic reduction as well as the perfect application of the interfragmentary and axial compression techniques and the addition of cancellous bone graft. It is because of these reasons, seen as difficulties by some people, that many have switched to the interlocked nailing and prefer not to bother with the reduction of the third fragment. Healing is then obtained by a voluminous callus that includes the third fragment.	For the fractures of the distal third, where the medullary canal flares and the cortex is thinner, we prefer anatomic reduction and internal fixation with the condylar blade plate or with a contoured straight plate. In this zone, the intramedullary nail by itself cannot tutor the axial loads nor neutralize the bending and torsional loads; the nail only acts as a buttress for the two distal screws that receive all these loads and may suffer failure breakage.