Alignment of supracondylar/intercondylar fractures of the femur after internal fixation by AO/ASIF technique.

Fifty-nine supracondylar-intercondylar fractures of the femur in 57 patients were evaluated after a mean follow-up of 5 years 7 months (range 2 years to 11 years 3 months) after internal fixation using AO/ASIF technique. Axial alignment was compared with that of the uninjured side by orthoroentgenography in the upright position and by bilateral anteroposterior (AP) and lateral views of the femur. Identical values for varus/valgus were noted in 24%, for ante/recurvation in 72%, and for rotation in 61%; differences were within 5 degrees of varus/valgus in 74%, of ante/recurvation in 78%, and of rotation in 83%. Alignment differences were more frequent in complicated and intercondylar fractures according to the AO classification of fractures. We conclude that restoration of the distal femoral angle is far more difficult than restoration of the sagittal plane and rotation, but a satisfactory functional result appears to be compatible with angulation differences of less than or equal to 5 degrees in any plane and that this difference appears to be within the reasonably achievable limits. 93% of the patients were satisfied; 64% of patients were pain-free, and 27% had slight intermittent pain (not interfering with daily activity); 67% of the patients had unlimited walking distance, and 78% of the patients were able to walk without aid. Excellent and good results according to the rating systems of Neer et al., Pritchett, and Schatzker and Lambert were noted in 82, 39, and 26%, respectively. This discrepancy between alignment, pain, function, and results according to different rating systems underlines the need for future standardized, clearly defined reporting and classification of rating.