- Distal Femoral Shaft Fractures
- Distal Femoral Phyeal Frx
- Supracondylar Fractures following TKR
- work up for femur fracture
: axial load to a flexed knee;
- Bimodal distribution:
- low energy fractures involving older females (often have
- high energy fractures involving younger males;
- associated injuries
- vascular Injury: 2-3% (similar to vessel injury in knee dislocations
- knee ligament injuries: 20% (most commonly the ACL
- tibial plateau fractures
are also common;
- pertinent surgical anatomy
(see: AO classification (Muller)
- must r/o a Hoffa extension (coronal plane fracture) in which case, a condylar buttress plate
- tunnel view
of the intercondylar notch is helpful in judging the displacement of vertical fractures into the jonit;
- in elderly patients who sustain low energy fractures it may be difficult to determine whether there is an intra-articular component;
- in these cases, consider obtaining a CT scan;
- Non Operative Therapy
- Operative Treatment:
(discussion and surgical approach)
- open supracondylar frx
- 95 deg. condylar blade plate
- dynamic screw and side plate
- condylar buttress plate
- locking plate fixation:
(see general concepts
- locking condylar plates (synthese menu)
- pre-contoured plates are general under contoured compared to native femoral anatomy;
- often first screw is inserted proximally into the cortex so that proper proximal-distal plate position is obtained;
- if screw is tightened down all the way, under-contoured plate will cause fracture reduction distortion (medialization of frx);
- consider loosely applying this screw so that it maintains the plate position, but allows the distal locking screws to
properly engage the distal fragment;
- once the distal screws have been inserted, the original proximal screw can be fully tightened down, which should result
in an optimally reduced fracture;
- rotational alignment:
- considerations for healing:
- non union
may be as high as 20%;
- bone healing with plates
- fracture union is more likely when there are empty holes in the plate adjacent to fractures;
- Failure of LCP Condylar Plate Fixation in the Distal Part of the Femur. A Report of Six Cases.
- 2010 mid-AOA MD in Training Award: healing complications are common after locked plating for distal femur fractures.
- Dynamization of locked plating on distal femur fracture
- Open distal femur frx treated with lateral locked implants: union, secondary bone grafting, and predictive parameters.
- Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study
- Motion Predicts Clinical Callus Formation: Construct-Specific Finite Element Analysis of Supracondylar Femoral Frx.
- IM nails for supracondylar fractures:
- IF of supracondylar femoral frx: comparative biomechanical performance of 95-degree blade plate and two retrograde nails.
- these authors used a modified retrograde IM nail (blade inserts into nail), and noted better stability than seen with standard
blade plate except in torsion
- Post Op Care
Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation
Double-plating of comminuted, unstable fractures of the distal part of the femur
Supracondylar fracture of the femur following prosthetic knee arthroplasty
Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur
Surgical treatment of displaced, comminuted fractures of the distal end of the femur
Rush-pin fixation of supracondylar and intercondylar fractures of the femur
Fractures of the distal femoral epiphyses. Factors influencing prognosis: a review of thirty-four cases
Physeal arrest about the knee associated with non-physeal fractures in the lower extremity
Supracondylar fracture of the femur: closed or open reduction?
Supracondylar femoral fractures in the frail elderly. Fractures in need of treatment
Alignment of supracondylar/intercondylar fractures of the femur after internal fixation by AO/ASIF technique.
The Treatment of Open Distal Femur Fractures With Immediate Open Reduction and Internal Fixation. Helpenstell T, et al. J Orthop Trauma. 1991;5:235.
Supracondylar fractures of the femur treated by external fixation
Treatment of Supracondylar Nonunions of the Femur with Plate Fixation and Bone Graft
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Clifford R. Wheeless, III, MD on Sunday, August 14, 2016 3:42 pm