BACKGROUND

Supracondylar femur fractures are severe injuries that can be technically challenging to operatively treat. Although they account for less than 1% of all fractures and between 3% and 6% of femur fractures, their incidence is likely to increase with the rising geriatric populations and the increasing number of peri-prosthetic injuries. 1 Injuries to the distal femur follow a bimodal distribution between geriatric low energy fractures and highenergy trauma. 1, 2 As with all fractures involving periarticular metaphyseal bone, treatment invariably includes understanding the fracture characteristics, careful preoperative planning, assessment of patient goals and health, bone quality, surgeon experience and implant selection. In the early 1960s, most distal femur fractures were managed conservatively with fracture bracing and traction, achieving acceptable results in 67% to 90% of patients. 3 However, with the advent of new surgical techniques and implants, the pendulum shifted from conservative management to surgical stabilization of these injuries.

Through historical review, Henderson and colleagues3 chronicled the increasing success rates with operative fixation from 52% to 54% in the 1960s, 73.5% to 75% in the 1970s, to 74% to 80% in the 1980s. Steady advances in our understanding of distal femoral anatomy and fracture biology have heralded various implant designs that further optimized successful treatment of these injuries. These modalities, each with their own merits and drawbacks, range broadly from external fixation, fixed-angle device (blade or sliding barrel implants), plate fixation (locked and unlocked), intramedullary nailing, arthroplasty, and distal femoral replacement (DFR)(Box 1). The authors intend to review these modalities and examine their success and pitfalls to provide a primer for the current clinical care of adult supracondylar femur fractures.