A pre-operative plan is drawn and surgical tactic developed. The patient is operated upon in the supine position with a bump under the affected hip on a radiolucent table. A tourniquet is not used. The standard lateral incision for exposure of the distal femur is marked on the skin.
The distal part of the skin is incised. The length of the incision is only that required for visualization of the articular surface. A sub-muscular window is made under the vastus lateralis. The joint is reduced and held with k-wires. An incision is made in the upper thigh in line with the skin marks. The incision begins just above the fracture and continues up the femur to allow for proximal screw placement. The plate is slid sub-muscularly up the lateral side of the femur.
Guides are inserted into the plate. The plate is attached to the distal femur by using the guide wires so that the guide wire for the 7.3mm screw is parallel to the knee joint axis on the ap and to the trochlear surface on the lateral. The plate should lie on the distal femoral lateral cortex. Alignment is verified fluoroscopically.
Screws are sequentially placed into the distal fragment. The initial screw was conical to compress the condylar components of the fracture. The plate is then held to the proximal femur and screws are sequentially placed after estimating correct femoral length. Unicortical locking screws are added as well. Post-fixation radiographs are shown in Figure 3 and Figure 4.