- Distal Femoral Shaft Fractures
- Distal Femoral Phyeal Frx
- Supracondylar Fractures following TKR
- work up for femur fracture
- mechanism: 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
- Radiographs: (see: AO classification (Muller))
- must r/o a Hoffa extension (coronal plane fracture) in which case, a condylar buttress plate is required;
- 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%;
- Non-union in lateral locked plating for distal femoral fractures: A systematic review.
- bone healing with plates
- fracture union is more likely when there are empty holes in the plate adjacent to fractures;
- Additional fixation of medial plate over unstable lateral locked plating of distal femur fractures: A biomechanical study.
- Failure of LCP Condylar Plate Fixation in the Distal Part of the Femur. A Report of Six Cases.
- 2010 mid-America Orthopaedic Association Physician 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 fractures 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 Fractures.
- Relationships between Hoffa fragment size and surgical approach selection: a cadaveric study
- IM nails for supracondylar fractures:
- Internal fixation of supracondylar femoral fractures: comparative biomechanical performance of the 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.
The Treatment of Open Distal Femur Fractures With Immediate Open Reduction and Internal Fixation. Helpenstell T, et al. J Orthop Trauma. 1991;5:235.