Supracondylar fractures of the femur: long-term follow-up of closed versus nonrigid internal fixation.

Twenty-nine patients were evaluated a minimum of ten years (average: 16 years) after femoral supracondylar fracture. Fracture type, mechanism of injury, and age of 14 patients initially treated nonoperatively were similar to those of 15 patients treated with nonrigid internal fixation. Complications were more common and more severe in the surgically-treated group. Knee range of motion remained permanently decreased in both groups, averaging 3 degrees lack of extension to 63 degrees of flexion. In both groups, 60% had symptoms of knee pain, instability, and gait abnormalities. Long-term poor results were caused by degenerative arthritis or loss of knee motion (or both). Degenerative arthritis developed in patients whose fracture healed with articular incongruity, greater that 15 degrees of valgus, any amount of varus, or a loss of normal mechanical axis. Results were satisfactory in seven of 15 patients in the surgical group and eight of 14 in the nonoperative group.