Distal femur fractures assessment and preop planning ota lecture series iii l5a. These fractures often involve the cartilage surface of the knee joint and are most commonly seen in people with severe osteoporosis or those who have previously undergone total knee replacement surgery. Fractures of femur requiring urgent orthopaedic referral. Download pdf bmc musculoskeletal disorders biomed central. Distal femur fractures most often occur either in older people whose bones are weak, or in younger people who have high energy injuries, such as from a car crash. Effective management of periprosthetic fractures of the distal femur requires knowledge of both fracture fixation techniques and revision arthroplasty. Distal radius buckle fractures are common in children and typically present after a fall on an outstretched hand.
It acts as the site of origin and attachment of many muscles and ligaments, and can be divided into three parts. Distal femoral fractures should be treated without disturbing knee or lower extremity function. Patients who sustain this injury are at risk for a variety of complications including. Introduction prior to 1970 treated nonoperatively causing many complications 1. Distal femur fractures include fractures of the supracondylar and intercondylar region and are relatively common injuries. Distal femur, fracture, supracondylar and intercondylar fracture, internal fixation, biomechanics.
Fractures of the distal femur constitute a heterogenous group of injuries affecting the knee. Our work is a retrospective study of 17 cases of distal femur fracture colligated in the department of orthopaedic surgery. We help you diagnose your distal femur case and provide detailed descriptions of how to manage this and hundreds of other pathologies. Pdf management of distal femur fractures in adults an. Due to their high complication rate and negative impact of those complications upon the knee and the whole lower limb, distal femoral fractures require optimal. Download full thesis topics for ms dnb orthopaedics degree. Note bucket handle appearance of distal metaphysis above. In both the elderly and the young, the breaks may extend into the knee joint and may shatter the bone into many pieces. The femur is the only bone in the thigh and the longest bone in the body. What is the classification of distal femur fractures there is no widely used classification system to describe distal femur fractures, and most fractures are classified by location supracondylar, intercondylar, or condylar, pattern spiral, oblique, or transverse, comminution, articular involvement, displacement, and angulation. Medical complications and outcomes after hip fracture repair.
Treatment options for distal femoral fractures ncbi. Three commonly used implants implants a, b and c are shown in figures a, b and c respectively. Supracondylar, condylar, and intercondylar extension greenspan 1992 821p. Hip fractures and femoral shaft fractures in children are discussed separately. The two most successful treatment options for periprosthetic distal femur fractures were locking plate 87% and intramedullary nailrod 84%. A recent study reported coronal plane fracture in 38. Intraarticular physeal fractures of the distal femur. Historically these fractures have been associated with poor outcomes secondary to the challenges presented by. Fractures of the upper end of the thigh bone are referred to as proximal femur fractures or hip fractures in medical terms. Up to 32% healing problems in distal femur fractures treated with locking plates. The distal femur is where the bone flares out like an upsidedown funnel. Epiphyseolysis can be divided into several categories that are based on the original salterharris classification tab. Femur shaft fractures broken thighbone orthoinfo aaos.
These fractures most commonly occurs with twisting motions or falls. Comparison of radiological and functional outcome in patients with fracture shaft of humerus treated with interlocking nailing and with plate osteosynthesis. Both periprosthetic femoral shaft and distal femur fractures are associated with relatively high mortality rates, approaching that of patients with hip fractures. Periprosthetic distal femur fracture after total knee. Classification of distal femur fractures and their clinical.
In this article, we shall look at the anatomy of the femur its attachments, bony landmarks and clinical correlations. Fractures of the distal femur occur most frequently either as highenergy injuries in young men or lowenergy fractures in elderly women. Distal femur fractures in adults orthopaedics and trauma. Pdf this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. Extraarticular distal femur retrograde imn dont forget to reduce the fracture before placing distal interlocks. In more complex fractures, ct is used to delineate intraarticular extension, degree of comminution, and fracture lines in the coronal plane. Distal femoral fractures have been reported to account for between 4%57 and 7%95 of all femoral fractures, which in.
The full text of this article is available in pdf format. The system allows for polyaxial screw placement with subsequent screw. Mortality after distal femur fractures in elderly patients. Supracondylar femoral fractures hoffa fracture 33b3 coronal split posterior femoral condyle no dcs dynamic condylar screw no blade plate 7. Distal femur fractures are uncommon, but an important cause of patient morbidity. Monoaxial locking plate for treating distal femur fractures. Chapter 53 fractures of the distal femur china quad diaries. Distal femur thighbone fractures of the knee a fracture is a broken bone. These injuries are often complicated by osteopenia of the distal femur secondary to stress shielding or osteolysis. Epiphyseolysis in the distal femur epiphysis in children is not a frequent injury fig. Distal femur plate distal femur locked plate duration. The distal femoral nail dfn is indicated for the stabilization of fractures of the distal femur. Fractures of the thigh bone that occur just above the knee joint are called distal femur fractures. Therefore, it is important to consider all treatment options according to the patients age, fracture type, level of adjacent soft tissue injuries, and risk of complications.
The incidence of distal femur fractures among all orthopedic injuries is less than. At the distal end of the femur, supracondylar fractures tend to occur more often. A supracondylar femur fracture, also called a distal femur, is an unusual injury that occurs just above the knee joint. Distal femur fracture an overview sciencedirect topics. The location of the fracture the femoral shaft is divided into thirds.
The most frequent complications associated with periprosthetic distal femur fractures included. See hip fractures in children and femoral shaft fractures in children. Supracondylar femur fracture adult distal femur trauma options. This classification takes into account the involvement of anatomic region of the distal femur, the energy of the injury and also prognosticates the outcome. Supraintercondylar fractures, supracondylar fractures, femur, condylar buttress plates. In elderly patients, distal femur fractures are the second most frequent fragility fractures of the femur following those of the hip 1, 35, 36, and these patients are at elevated risk for complications, given the high prevalence of medical.
From a populationbased implant design, a patented screwtoplate interface, and streamlined instrumentation, our focus. Open fractures of the distal femur present several challenges to the treating surgeon as well as the patient. Technique guide instruments and implants approved by the ao foundation. Christopher haydel, md department of orthopaedic surgery and sports medicine updated 052016. A prospective analysis of functional outcome of displaced distal femur fractures internally fixed with distal femur locking compression plate. For intramedullary fixation of proximal femur fractures. Distal femur fractures orthopaedic trauma association ota. Amsterdam pediatric wrist rules may be used to guide decision making in obtaining radiographs in patients presenting with pain after wrist trauma but 23v wrist radiographs are the definitive. Many reports in the past have included fractures in the distal one third of the femur, thereby mixing diaphyseal, metaphyseal, and intraarticular fractures in the same series. Eightyfive per cent of the coronal plane fractures involved the lateral condyle and 9% incorporated both condyles.
A fracture of the distal femur is a break or crack that occurs anywhere within the lower region of the femur near the knee fractures of the distal femur are usually caused by direct injuriestrauma to the leg, associated with falls, participation in contact sports, or automobile accidents. Spiral fracture of femur in a 3 month old which was the result of nai. Aug 06, 2017 supracondylar femoral fractures muller ao classification of fractures 3 femur 33 distal femur a1 a2 a3 b1 b2 b3 c1 c2 c3 c complete articular a extraarticular b partial articular 6. Distal femur thighbone fractures of the knee orthoinfo aaos. Distal femur fractures most often occur either in older people whose bones are weak or in younger people who have high energy injuries, such as from a car crash. The knee is the largest weightbearing joint in your. In this study, plain radiographs alone did not identify 31% of. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Nail will not have an isthmic fit may need blocking pinsdrill bitsscrews percutaneous or open clamps nail will lock a fracture in a malreduced position as easily as it will lock a fracture reduced. Distal femur lecture orthopaedic trauma association. Whether they are transverse, oblique, or comminuted, supracondylar or intercondylar in a t, y or v fashion their management still evokes much controversy because of the consistently poor results obtained. Distal femur fractures in pediatrics patients are discussed here. Transverse fracture with displacement and shortening.
Spanning knee external fixation allows for temporary stabilization of fracture if delayed reconstruction is necessary external fixator as a reduction aid at time of definitive reconstruction. Periprosthetic fractures of the distal femur most commonly present as fragility fractures associated with relatively minor trauma. Sep 14, 2018 a fracture of the distal femur is a break or crack that occurs anywhere within the lower region of the femur near the knee fractures of the distal femur are usually caused by direct injuriestrauma to the leg, associated with falls, participation in contact sports, or automobile accidents. Management of distal femur fractures in adults orthopedic clinics. All fractures of the femur in children should be referred to the orthopaedic team. Locking plate fixation of distal femoral fractures is a. Presently, published reports describe use of a variety of implants with or without bone grafting, substantiating the absence of consensus about the optimal treatment for nonunions of the distal femur. Professor thomas ruedi, professor emeritus from the university of. Management of fractures of distal femur journal of medical. Nail will not have an isthmic fit may need blocking pinsdrill bitsscrews percutaneous or open clamps nail will lock a fracture in a malreduced position as easily as it will. This publication is not intended for distribution in the usa. Among all the classifications described for distal femur fractures, the muller ao classification system is the most widely accepted system and is being used worldwide. Geriatric distal femur, or supracondylar, fractures are common fragility fractures.
Randomised trial of the fascia iliaca block versus the 3in1 block for femoral neck fractures in the emergency department. It can also be used for diaphyseal fractures in which a retrograde approach is indicated e. Distal femur fractures orthopaedic trauma association. Management of fractures of distal femur journal of.
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