Date: Mon, 18 Jun 2001 17:06:36 -0400

Subject: Medial Femoral Condyle Malunion

Patient is a 45 yo homeless male that was struck by a car 3 months ago. He had left type 3A open prox tibia fx treated w/ a LISS and no problems in follow up. He also had a left medial femoral condyle fx that was impacted. The MFC had an ORIF and bone grafting, but has gone into varus w/ loss of the MFC reduction. He is now 3 months post injury w/ 15 degrees of varus and ROM of 20-120.

Varus AP 3 mos
post ORIF
Varus lat 3 mos

Any suggestions? Osteotomy (femoral or tibial) vs revision ORIF?

Bill Obremskey MD MPH
University of North Carolina
Dept. of Orthopedics

Reply at: Orthopaedic Trauma Association forum

Date: Mon, 18 Jun 2001 16:54:03 -0500

From: Marc F. Swiontkowski, M.D.

Bill- I vote revision ORIF with ICBG- need longer anterior to posterior screws placed in lag manner. I believe the Hoffa component would remain un-united with a supracondylar osteotomy.


Marc F. Swiontkowski, M.D.
Professor and Head
Univ. of Minnesota Dept. Orthopaedic Surgery

Date: Mon, 18 Jun 2001 17:20:54 -0500

From: Adam Starr

I think if the wounds are well healed I'd try to fix that one again, and buttress my repair with a little plate in addition to the screws.

Adam Starr
Dallas, Texas

Date: Mon, 18 Jun 2001 20:27:27 -0700

From: Janet Chandler

Medial opening wedge supracondylar osteotomy

Date: Tue, 26 Jun 2001 07:25:46 -0600

From: Thomas A. DeCoster

what did you do with the distal femur fracture (medial condyle) that settled after ORIF?

Date: Wed, 27 Jun 2001 16:39:06 -0400

From: William Obremsky


I opened his knee and removed the Hardware. The articular surface was smooth and healed. I felt that the entire Hoffa fragment must have settled w/ the distal femora articular surface and healed. A manipulation eliminated the flexion deformity, which I believe was due to posterior capsule contracture. I decided not to do a hemicondyle osteotomy and fixation. He is walking w/ a walker and going back to his tent tommorow. If his knee is a problem in several months, I will do an HTO. Doing a compensatory instead of a corrective osteotomy goes against my grain, but in this case I thought it was best. I do not know yet if I was Chicken or Wise.

Bill Obremskey