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A Y Shin - One of the best experts on this subject based on the ideXlab platform.
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intraoperative anatomy of the vascular supply to the medial Femoral Condyle
Journal of Plastic Reconstructive and Aesthetic Surgery, 2019Co-Authors: Nicholas Pulos, Allen T Bishop, A Y ShinAbstract:The arterial anatomy of the medial Femoral Condyle (MFC) for vascularized bone grafting has been extensively studied in cadaveric specimens. A majority of cadaveric studies have limited numbers of specimens, and the data from these studies are extrapolated to the surgical environment. The purpose of this study is to evaluate the vascular anatomy of the medial Femoral Condyle in a large clinical series. A retrospective review of operative reports was conducted of medial Femoral Condyle and trochlea vascularized bone grafts performed by the senior surgeons between 2005 and 2018. A total of 113 patients were included in the study. Demographic data, preoperative diagnosis, and type of graft harvested were collected. The descending genicular artery, a branch of the superficial Femoral artery, was the dominant pedicle in 77% of cases. It was also the dominant arterial pedicle for medial Femoral trochlea (MFT) bone grafts in 7 out of the 9 cases (77.8%). The superomedial genicular artery was the dominant pedicle in 23% (26 of 113 total) of all cases. In eight patients, a descending genicular branch was not identified. The superomedial genicular artery was absent in 2% of cases (2 of 113). The descending genicular artery was the dominant arterial pedicle for vascularized bone grafts from the medial femur and was present in 93% of cases. This is in contrast to published cadaveric studies showing the artery was present in 89% of specimens.
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primary medial Femoral Condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis
Journal of Hand Surgery (European Volume), 2019Co-Authors: Kathleen M Kollitz, Nicholas Pulos, Allen T Bishop, A Y ShinAbstract:This study aimed to determine the outcome of free vascularized medial Femoral Condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and ...
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primary medial Femoral Condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis
Journal of Hand Surgery (European Volume), 2019Co-Authors: Kathleen M Kollitz, Nicholas Pulos, Allen T Bishop, A Y ShinAbstract:This study aimed to determine the outcome of free vascularized medial Femoral Condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and intraoperatively documented avascular necrosis. Thirty-two patients (28 male, four female) met the inclusion criteria. Median time from injury to surgery was 70 weeks. Thirty of 32 patients healed at a median of 12 weeks. There was significant improvement from preoperative to postoperative lateral intrascaphoid angle, scapholunate angle, and radiolunate angle. Two scaphoids failed to unite; one patient underwent scaphoidectomy and four-corner fusion 15 months postoperatively after suffering a subsequent injury. Another patient underwent 1,2-intercompartmental supraretinacular artery-based vascularized bone grafting at 4 months postoperatively and then scaphoid excision with four-corner fusion 4 years later. The free vascularized medial Femoral Condyle bone graft restores scaphoid vascularity and architecture while promoting union in a subset of scaphoid nonunions that has historically been a clinical challenge. Level of evidence: IV.
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donor site morbidity and functional status following medial Femoral Condyle flap harvest
Plastic and Reconstructive Surgery, 2018Co-Authors: Ghassan Mehio, A Y Shin, Allen T Bishop, Steven L Moran, Mohamed Morsy, Cenk Cayci, Diya M Sabbagh, Brian T CarlsenAbstract:BACKGROUND The medial Femoral Condyle free vascularized bone flap is a valuable alternative to other types of vascularized bone grafts. The donor-site morbidity and functional outcomes after flap harvest have not been fully appreciated. The authors report the postoperative outcomes and analyze the impact of increasing the size of the flap on knee donor-site morbidity. METHODS A retrospective chart review of patients who underwent medial Femoral Condyle flap surgery between 2001 and 2012 at their institution was performed. The size of the flap was stratified, based on the largest dimension, into three groups. Demographics, outcomes, and complications related to the flap donor site were recorded and analyzed. Subsequently, functional status was assessed by administering a validated condition-specific measure. A univariate logistic regression analysis was performed, and results were analyzed. RESULTS A total of 75 patients were identified. Average age was 29.5 ± 15.2 years. Average follow-up time was 13 months. The overall complication rate was 18.6 percent. Paresthesia in the saphenous nerve distribution was the most common complication. Increasing the size of the flap resulted in a significant elevation in complication risk (p < 0.05). A total of 47 patients completed the Lower Extremity Functional Scale questionnaire. The average Lower Extremity Functional Scale score was 72.12 ± 14.18. Fifty-one percent (n = 24) scored 80 points, indicating a normal level of function on average. CONCLUSIONS The medial Femoral Condyle flap has overall acceptable donor-site morbidity, with a good level of function postoperatively. Larger flaps are associated with a greater number of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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free vascularized medial Femoral Condyle autograft for challenging upper extremity nonunions
Hand Clinics, 2012Co-Authors: D B Jones, Peter C Rhee, Allen T Bishop, A Y ShinAbstract:Free vascularized bone grafts from the medial Femoral Condyle have increasingly demonstrated utility in the successful treatment of challenging nonunions and bony defects. The consistent, robust vascular anatomy and the versatility to function as either a thin, flexible periosteal or corticoperiosteal graft or as a structural corticocancellous graft have made this graft a valuable option for addressing recalcitrant nonunions. The rationale, indications, vascular anatomy, and surgical technique of harvesting these grafts from the medial Femoral Condyle are presented.
Allen T Bishop - One of the best experts on this subject based on the ideXlab platform.
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intraoperative anatomy of the vascular supply to the medial Femoral Condyle
Journal of Plastic Reconstructive and Aesthetic Surgery, 2019Co-Authors: Nicholas Pulos, Allen T Bishop, A Y ShinAbstract:The arterial anatomy of the medial Femoral Condyle (MFC) for vascularized bone grafting has been extensively studied in cadaveric specimens. A majority of cadaveric studies have limited numbers of specimens, and the data from these studies are extrapolated to the surgical environment. The purpose of this study is to evaluate the vascular anatomy of the medial Femoral Condyle in a large clinical series. A retrospective review of operative reports was conducted of medial Femoral Condyle and trochlea vascularized bone grafts performed by the senior surgeons between 2005 and 2018. A total of 113 patients were included in the study. Demographic data, preoperative diagnosis, and type of graft harvested were collected. The descending genicular artery, a branch of the superficial Femoral artery, was the dominant pedicle in 77% of cases. It was also the dominant arterial pedicle for medial Femoral trochlea (MFT) bone grafts in 7 out of the 9 cases (77.8%). The superomedial genicular artery was the dominant pedicle in 23% (26 of 113 total) of all cases. In eight patients, a descending genicular branch was not identified. The superomedial genicular artery was absent in 2% of cases (2 of 113). The descending genicular artery was the dominant arterial pedicle for vascularized bone grafts from the medial femur and was present in 93% of cases. This is in contrast to published cadaveric studies showing the artery was present in 89% of specimens.
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primary medial Femoral Condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis
Journal of Hand Surgery (European Volume), 2019Co-Authors: Kathleen M Kollitz, Nicholas Pulos, Allen T Bishop, A Y ShinAbstract:This study aimed to determine the outcome of free vascularized medial Femoral Condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and ...
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primary medial Femoral Condyle vascularized bone graft for scaphoid nonunions with carpal collapse and proximal pole avascular necrosis
Journal of Hand Surgery (European Volume), 2019Co-Authors: Kathleen M Kollitz, Nicholas Pulos, Allen T Bishop, A Y ShinAbstract:This study aimed to determine the outcome of free vascularized medial Femoral Condyle bone grafts in the primary treatment of scaphoid nonunions with scaphoid foreshortening or carpal collapse and intraoperatively documented avascular necrosis. Thirty-two patients (28 male, four female) met the inclusion criteria. Median time from injury to surgery was 70 weeks. Thirty of 32 patients healed at a median of 12 weeks. There was significant improvement from preoperative to postoperative lateral intrascaphoid angle, scapholunate angle, and radiolunate angle. Two scaphoids failed to unite; one patient underwent scaphoidectomy and four-corner fusion 15 months postoperatively after suffering a subsequent injury. Another patient underwent 1,2-intercompartmental supraretinacular artery-based vascularized bone grafting at 4 months postoperatively and then scaphoid excision with four-corner fusion 4 years later. The free vascularized medial Femoral Condyle bone graft restores scaphoid vascularity and architecture while promoting union in a subset of scaphoid nonunions that has historically been a clinical challenge. Level of evidence: IV.
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donor site morbidity and functional status following medial Femoral Condyle flap harvest
Plastic and Reconstructive Surgery, 2018Co-Authors: Ghassan Mehio, A Y Shin, Allen T Bishop, Steven L Moran, Mohamed Morsy, Cenk Cayci, Diya M Sabbagh, Brian T CarlsenAbstract:BACKGROUND The medial Femoral Condyle free vascularized bone flap is a valuable alternative to other types of vascularized bone grafts. The donor-site morbidity and functional outcomes after flap harvest have not been fully appreciated. The authors report the postoperative outcomes and analyze the impact of increasing the size of the flap on knee donor-site morbidity. METHODS A retrospective chart review of patients who underwent medial Femoral Condyle flap surgery between 2001 and 2012 at their institution was performed. The size of the flap was stratified, based on the largest dimension, into three groups. Demographics, outcomes, and complications related to the flap donor site were recorded and analyzed. Subsequently, functional status was assessed by administering a validated condition-specific measure. A univariate logistic regression analysis was performed, and results were analyzed. RESULTS A total of 75 patients were identified. Average age was 29.5 ± 15.2 years. Average follow-up time was 13 months. The overall complication rate was 18.6 percent. Paresthesia in the saphenous nerve distribution was the most common complication. Increasing the size of the flap resulted in a significant elevation in complication risk (p < 0.05). A total of 47 patients completed the Lower Extremity Functional Scale questionnaire. The average Lower Extremity Functional Scale score was 72.12 ± 14.18. Fifty-one percent (n = 24) scored 80 points, indicating a normal level of function on average. CONCLUSIONS The medial Femoral Condyle flap has overall acceptable donor-site morbidity, with a good level of function postoperatively. Larger flaps are associated with a greater number of complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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free vascularized medial Femoral Condyle autograft for challenging upper extremity nonunions
Hand Clinics, 2012Co-Authors: D B Jones, Peter C Rhee, Allen T Bishop, A Y ShinAbstract:Free vascularized bone grafts from the medial Femoral Condyle have increasingly demonstrated utility in the successful treatment of challenging nonunions and bony defects. The consistent, robust vascular anatomy and the versatility to function as either a thin, flexible periosteal or corticoperiosteal graft or as a structural corticocancellous graft have made this graft a valuable option for addressing recalcitrant nonunions. The rationale, indications, vascular anatomy, and surgical technique of harvesting these grafts from the medial Femoral Condyle are presented.
Scott L Levin - One of the best experts on this subject based on the ideXlab platform.
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the use of a free vascularized osteocuteanous flap from the medial Femoral Condyle for two separate cases of ulnar shaft nonunions in a single patient a case report
Orthoplastic Surgery, 2021Co-Authors: Viviana Serra M Lopez, Brian A Perez, Agnes Z Dardas, Scott L LevinAbstract:Abstract The free vascularized osteocutaneous flap from the medial Femoral Condyle is an attractive option for limb salvage given its low donor morbidity site and reliable vascular supply. Its use was originally described for the use of nonunions with small bony defects and has shown reliable results for a variety of reconstructive needs. We present a case of a female patient who underwent two free vascularized corticoperiosteal medial Femoral Condyle grafts to her right ulna during two separate surgeries for treatment of consecutive ulnar shaft nonunions. The patient had a prior malignant soft tissue tumor resection of her forearm followed by chemotheraphy and radiation, which presented unique challenges during their course of limb salvage. Six months after the most recent procedure, the patient has a functional limb and no evidence of nonunion on imaging.
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the medial Femoral Condyle flap in the pediatric patient
Plastic and Reconstructive Surgery, 2021Co-Authors: David L Colen, Katarzyna E Kania, Sammy Othman, Scott L Levin, Edward M Reece, William C Pederson, Marco Innocenti, Stephen J KovachAbstract:BACKGROUND The use of free flaps from the medial Femoral Condyle has grown in popularity and is now a workhorse in the reconstruction of skeletal defects. The utility of this technique has not yet been described for the pediatric patient population. The authors present their series of pediatric patients who underwent surgery using a medial Femoral Condyle free flap or a variant thereof in skeletal reconstruction and demonstrate the efficacy of this technique in this population. METHODS A multi-institutional retrospective review of patients aged 18 years or younger who required a medial Femoral Condyle flap for skeletal reconstruction was undertaken. Operative technique, radiographs, and clinical outcomes were recorded. A novel technique (Innocenti) was used to avoid the distal Femoral physis in which a Kirschner wire was placed under fluoroscopic guidance just proximal to the growth plate. RESULTS Thirteen patients met inclusion criteria, with an average age of 14.7 years (range, 7 to 18 years) and mean follow-up of 28 months (range, 3 to 120 months). Six were skeletally immature at the time of medial Femoral Condyle harvest, with the last patient having organic bone disease, putting her at risk for pathologic fracture. All 13 patients achieved bony union, and no patients suffered pathologic fractures or physeal injuries; no patients developed length discrepancies. CONCLUSIONS The authors present the first series of corticocancellous medial Femoral Condyle free flaps in the pediatric population along with a novel technique to avoid injury to the physis in skeletally immature patients. This technique is effective for a variety of skeletal defects or nonunions and is safe for growing patients without causing physeal arrest or growth disturbance. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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medial Femoral Condyle free flap reconstruction of complex foot and ankle pathology
Foot & Ankle Orthopaedics, 2019Co-Authors: John T Stranix, Merisa Piper, Said C Azoury, Geoffrey M Kozak, Oded Benamotz, Keith L Wapner, Scott L LevinAbstract:Background:Complex hindfoot pathology may benefit from vascularized bone flap reconstruction rather than traditional bone grafting techniques. Medial Femoral Condyle (MFC) flaps provide vascularize...
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medial Femoral Condyle microvascular bone transfer as a treatment for capitate avascular necrosis surgical technique and case report
Journal of Hand Surgery (European Volume), 2017Co-Authors: Nikolas H Kazmers, Joshua C Rozell, Kevin M Rumball, Scott H Kozin, Dan A Zlotolow, Scott L LevinAbstract:Avascular necrosis (AVN) of the capitate is a rare clinical entity for which a variety of treatment options have been described, ranging from immobilization to microvascular bone transfer. Outcomes following medial Femoral Condyle corticocancellous free flap reconstruction have not been reported for this specific pathology. We present the case of a 16-year-old girl with posttraumatic capitate AVN who was treated with curettage and medial Femoral Condyle corticocancellous vascularized bone grafting. At 18 months after surgery, the patient remains pain-free and had resumed all activities including lifeguarding by 6 months after surgery. This microsurgical technique, described previously for AVN of the scaphoid and lunate, may be applied in a similar fashion for the capitate with promising clinical results. Type of study/level of evidence Therapeutic V.
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a scapholunate ligament sparing technique utilizing the medial Femoral Condyle corticocancellous free flap to reconstruct scaphoid nonunions with proximal pole avascular necrosis
Journal of Hand Surgery (European Volume), 2016Co-Authors: Nikolas H Kazmers, Stephanie Thibaudeau, Scott L LevinAbstract:This article demonstrates a technique for the treatment of scaphoid fracture waist and proximal pole nonunions with avascular necrosis using a free vascularized medial Femoral Condyle flap. We present our surgical technique and representative case examples in which the scapholunate ligament, a key structure required to preserve carpal kinematics, is spared.
James P Higgins - One of the best experts on this subject based on the ideXlab platform.
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functional reconstruction of subtotal thumb metacarpal defect with a vascularized medial Femoral Condyle flap case report
Journal of Hand Surgery (European Volume), 2014Co-Authors: Victor W Wong, James P Higgins, Ryan D KatzAbstract:Devastating hand injuries require customized reconstructive strategies to maximize functional outcomes. We report a case of thumb metacarpal reconstruction using a vascularized medial Femoral Condyle osteocutaneous flap in the setting of nearly complete metacarpal loss. In addition to achieving the traditional goals of reconstructing thumb length and providing stability, the medial Femoral Condyle flap allowed motion at the carpometacarpal joint. The patient's hand function was further optimized by a component transfer of a proximally injured but distally preserved index finger to the amputated middle finger position. The patient regained satisfactory grip and thumb function with minimal donor site morbidity. This case highlights the role of both creative and established approaches to reconstruct composite tissues following devastating hand injury.
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medial Femoral Condyle flap donor site morbidity a radiographic assessment
Plastic and Reconstructive Surgery, 2013Co-Authors: Samir S Rao, Carlton C Sexton, James P HigginsAbstract:BACKGROUND The medial Femoral Condyle has become a reliable source of vascularized bone with many advantages to the reconstructive microsurgeon. The authors examined the donor-site morbidity of medial Femoral Condyle flap harvest. METHODS A retrospective review of all patients who underwent medial Femoral Condyle free flap procedures between April of 2009 and December of 2010 was conducted. Study participants underwent computed tomographic scans of their bilateral distal femurs and knee joints to evaluate the donor site and examine differences between the operated and nonoperated sides. RESULTS Fifteen patients underwent medial Femoral Condyle free flap procedures. Ten of them agreed to participate in the study. The average time between surgery and computed tomographic scans was 18.0 months (range, 12.2 to 30.4 months). Average bone harvested per procedure was 16.1 cm3 (range, 2 to 34 cm3), representing an average condylar volume of 9 percent (range, 1 to 18 percent). Reparative bone formation was minimal, with an average thickness of 4.5 mm (range, 4 to 6 mm). There were no findings of new degenerative joint disease on computed tomographic scans resulting from medial Femoral Condyle harvest. The flap success rate was 100 percent (10 of 10) for patency and achieving osseous union. There were no major or flap-related complications. Two patients reported numbness of the donor site at long-term follow-up (average, 17.5 months; range, 12.2 to 30.4 months). CONCLUSIONS Medial Femoral Condyle harvest creates minimal donor-site morbidity according to radiographic measures at more than 1-year follow-up. Surgeons can anticipate minimal unassisted bone regeneration at the donor site at this time interval.
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cutaneous angiosome territory of the medial Femoral Condyle osteocutaneous flap
Journal of Hand Surgery (European Volume), 2012Co-Authors: Matthew L Iorio, Derek Masden, James P HigginsAbstract:Purpose The medial Femoral Condyle flap is used for treatment of nonunions with or without intercalary bone loss. Most reported uses have been without a skin segment, but this flap can provide a skin component supplied by the saphenous artery branch (SAB) of the descending genicular artery (DGA) pedicle. Experience with this flap suggests that an additional distinct, reliable, more-distal, DGA-cutaneous branch can be found at Condyle level, capable of supporting skin without using the SAB. This cadaver study evaluated SAB and DGA-cutaneous branch angiosome territories. A clinical case series assesses the DGA-cutaneous branch's clinical utility. Methods The DGA and SAB were isolated in 12 cadaveric legs, divided, and separately cannulated. Red dye and methylene blue were selectively injected into each vessel manually. Skin perfusion was measured and photographed. Results In all specimens, the DGA was present, originating 14.2 cm proximal to the joint line, and demonstrated a distinct cutaneous branch at Condyle level. This vessel provided an average perfusion area of 70 cm 2 , centered over the medial knee. The SAB was identified in 11 specimens (92%), with an average perfusion area of 361 cm 2 along the medial aspect of the distal thigh and proximal leg. The DGA communicating branch was present and used for perfusion of the skin paddle in 17 of 20 cases. The SAB was present in 18 of 20 cases, used with DGA-communicating branch in 4 cases, and the sole source of skin perfusion in 1 case. In 2 remaining cases, neither the SAB nor DGA communicating branch was adequate for perfusion of a skin segment. Conclusions The medial Femoral Condyle flap can be harvested with a large skin paddle based on the SAB. A smaller skin segment can be harvested using the more distal DGA-communicating branch at Condyle level. Clinical relevance Improved understanding of the skin island associated with the DGA's saphenous and cutaneous branches can provide a rapid, reliable method of skin-segment harvest.
Richard Buckley - One of the best experts on this subject based on the ideXlab platform.
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coronal plane partial articular fractures of the distal Femoral Condyle current concepts in management
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: M H Arastu, M C Kokke, P J Duffy, R Korley, Richard BuckleyAbstract:Coronal plane fractures of the posterior Femoral Condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior Femoral Condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal Femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the Femoral Condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures.
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coronal plane partial articular fractures of the distal Femoral Condyle current concepts in management
Journal of Bone and Joint Surgery-british Volume, 2013Co-Authors: M H Arastu, M C Kokke, P J Duffy, R Korley, Richard BuckleyAbstract:Coronal plane fractures of the posterior Femoral Condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior Femoral Condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal Femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the Femoral Condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures. Cite this article: Bone Joint J 2013;95-B:1165–71.
