Supracondylar fracture of the femur: closed or open reduction?

Fifty-one cases of supracondylar fracture of the femur with a mean follow-up of 29 months were retrospectively studied. Thirty-one fractures were open; most had major soft tissue damage. Open management was used for 32 of the fractures with good to excellent results in 81%, while a good or excellent outcome was attained in only 42% of the 19 fractures treated nonsurgically. Malunion was observed in seven cases treated by closed methods and in only one case treated by open reduction. The patients treated surgically also had shorter average hospital stays and a better range of motion in the knee, while the rates of deep infection (three cases) and nonunion (two cases) were similarly distributed between the surgically and nonsurgically managed groups. Twelve patients required closed knee manipulation to improve knee motion, five in the group treated by closed reduction and seven in the group treated surgically with an average gain in motion of 52 degrees in the former and 42 degrees in the latter group.