This chapter deals only with fractures that involve the supracondylar metaphyseal or intercondylar epiphyseal areas of the distal end of the femur. Periprosthetic distal femur fracture after total knee. Sep 10, 2010 the ageadjusted charlson comorbidity index may serve as a useful tool to predict survival after distal femur fractures. Jul 31, 2018 a broken femur is usually caused by a severe accident.
Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Randomised trial of the fascia iliaca block versus the 3in1 block for femoral neck fractures in the emergency department. Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures. A fracture that occurs at the distal end of the femur bone, which includes the femoral condyles and the metaphysis. The distal femur is where the bone flares out like an upsidedown funnel. Distal femur 1040% nonunions 525% infections 520% malunion 1095% bone graft slatis et al. Locking plate fixation of distal femoral fractures is a. Usefulness of bilateral plate fixation for periprosthetic. Bennett fracturedislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal.
Surgical delay greater than 4 days increases the 6month and 1year mortality risks. Mortality after native fractures of the distal femur in the geriatric population is high and similar to mortality after hip fractures. Distal femur thighbone fractures of the knee orthoinfo. The full text of this article is available in pdf format. Surgical approach surgeon may use an anterolateral or lateral parapatellar approach. Evacuation of fracture hematoma traditional open plating.
We treated 87 patients with supraintercondylar or supracondylar femur fracture from 2004 to. These fractures typically occur in the distal radius after longitudinal trauma. In one series from sweden, up to 84% of distal femoral fractures occurred in patients older than 50 years. With long forceps, hold the radiographic ruler 357. Distal femoral fractures occur predominantly in two patient populations. The majority of trauma and orthopaedic surgeons are not expected to come across this injury. This zone varies greatly in the literature, from the distal 7. Use of nail traction splint in the management of proximal phalangeal fractures of the hand.
Distal femoral fractures engage the femoral metaphysis and the condyles. Femoral head fractures femoral neck fractures intertrochanteric fractures subtrochanteric fractures femoral shaft fractures distal femur fractures 3. Prep and drape the leg circumferentially extending proximal to the hip to allow proximal extension of the surgical incision if needed. Intraarticular fractures of distal femur present a huge surgical challenge. Success of the condylar screw plate for repair of a distal femur salterharris type iii fracture in a 2yearold horse suggests this implant has application in repair of selected distal femoral fractures in horses. It acts as the site of origin and attachment of many muscles and ligaments, and can be divided into three parts. The distal end of the femur traditionally encompasses the lower third of this bone.
Both periprosthetic femoral shaft and distal femur fractures are associated with relatively high mortality rates, approaching that of patients with hip fractures. Dualplating of the distal femur is required in some cases to achieve stable fixation. When treating nonunions of the distal femur, the ultimate goal is to achieve stable reduction while simultaneously preserving sufficient blood flow. Distal femur fractures may be accompanied by injury to localized skin, muscle, and joint ligaments and cartilage with the potential for decreased knee joint mechanics. Because of the anatomy of the distal femur, only surgical treatment is indicated to stabilize the fracture. A recent study reported coronal plane fracture in 38. A 37yearold female pedestrian who had been hit by a car sustained a comminuted supracondylar fracture of the left distal femur with an intercondylar extension. Ask the patient to wiggle all their fingers or toes distal to the injured site and determine if they can sense your touch. Oct 29, 2017 functional outcome of the distal femur locking compression plates in the treatment of fractures of distal femur. Over recent years, locking compression plate lcp has been shown good clinical results for the management of supracondylar femoral fracture. In our series in 2 out of 3 unsuccessfully cases we used plates with a length less than 9 holes. Fractures may result in damage to nerves and blood vessels. Distal femur fracture, psychiatric patient c101105 imam uddin trauma distal femur fractures 9112018 150. Communited distal femur fractures occur via high energy mechanism such as mcc plain film helpful in the trauma bay to quickly identify fractures ct scan often necessary to further classify fracture and assist with operative planning ct can also identify open fractures via air in joint or soft tissues.
Understanding the fracture imaging is essential femur. There are multiple alternatives for the definitive tre. Postoperative rehabilitation will depend on the severity of the fracture and surgical techniques used for reduction and fixation. Do you want to use the redesigned ao sr like an app. Nail will not have an isthmic fit may need blocking pinsdrill bitsscrews percutaneous or open clamps nail will lock a fracture in a malreduced. The system allows for polyaxial screw placement with subsequent screw locking for im proved stability especially within osteopenic. Distal condylar screws are parallel to the joint surface to provide a stable support structure in the metaphyseal region multiple points of fixation increased strength optimized fit percutaneous instrumentation stable support inspired by anatomy inspired. Traditionally young patients but increasing in geriatric population bimodal distribution. 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. The indications of a medial plate in addition to the lateral plate are medial supracondylar bone loss, low transcondylar bicondylar fractures, medial hoffa fracture, periprosthetic distal femur fractures, nonunion after failed fixation with single lateral plate, poor bone quality and comminuted distal. The skin around the fracture may be intact closed fracture or the bone may puncture the skin open fracture. Extraarticular distal femur retrograde imn dont forget to reduce the fracture before placing distal interlocks. Distal femur fractures in adults orthopaedics and trauma.
The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. Sometimes these fractures extend into the knee joint and separate the surface of the bone into a few or many parts. Functional outcome of the distal femur locking compression plates in the treatment of fractures of distal femur. Distal femur, fracture, supracondylar and intercondylar fracture, internal fixation, biomechanics. The distal femur is the area of the leg just above the knee joint. Distal femur fractures orthopaedic trauma association. 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. Supracondylar femur fracture adult distal femur trauma options.
The femoral neck is the most common location for a hip fracture. The femur is the only bone in the thigh and the longest bone in the body. Adjust the ruler until the distal end is at the desired nail insertion depth. Christopher haydel, md department of orthopaedic surgery and sports medicine updated 052016. Comparison of supraintercondylar and supracondylar femur. Neonatal physeal fracture of the distal femur is often difficult to diagnose. Femur shaft fractures broken thighbone orthoinfo aaos. A sterile tourniquet may be useful if treating a distal femur fracture. The location of the fracture the femoral shaft is divided into thirds. Ncb periprosthetic femur plate system surgical technique. Distal femur anatomic contoured locking compression plate lcp has shown to give one of the best results regarding recovery, fracture union. Distal femur zone from the articular surface to the metadiaphyseal junction approximately 15 cm from the articular surface. Timely and accurate diagnosis and appropriate therapy are critical in order to avoid permanent morbidity and.
Femur fracture were hip and femur fracture specialists providing the broadest portfolio of bestinclass products and services, unparalleled expertise, and the most expansive resources in the industry. Older adults can fracture their femur from a fall because their bones tend to be weaker. Distal femur thighbone fractures of the knee a fracture is a broken bone. In more complex fractures, ct is used to delineate intraarticular extension, degree of comminution, and fracture lines in the coronal plane. Locking compression plate in distal femoral intraarticular. Assess the skin color and temperature distal to the injury site. It consists primarily of a proximal femur plate, a distal femur plate, and a curved femur shaft plate. Distal femur fracture an overview sciencedirect topics. Download full thesis topics for ms dnb orthopaedics degree. In this article, we shall look at the anatomy of the femur its attachments, bony landmarks and clinical correlations. Doctors describe fractures to each other using classification systems.
Management of distal femur fractures in adults orthopedic clinics. Pdf current concepts in fractures of the distal femur. Gartlands classification of supracondylar fracture of humerus. Distal femur thighbone fractures of the knee orthoinfo aaos. 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. The incidence of distal femur fractures among all orthopedic injuries is less than. Assess for distal pulses, motor, and sensory function. Neonatal distal femoral physeal fracture requiring closed. Mortality after distal femur fractures in elderly patients. Medical complications and outcomes after hip fracture repair.
The ageadjusted charlson comorbidity index may serve as a useful tool to predict survival after distal femur fractures. The anatomical axis of the femur runs about 810 degrees laterally from the loading axis, which is connecting the centre of the femoral head with the middle of the talar joint line. Your digital gateway to expertise, education, and innovation. Only three cases of paediatric triplane fractures of the distal femur are described in the literature. With intercondylar split fracture patterns, the two heads may also cause the distal condylar fragments to separate and rotate. The femur, also known as the thigh bone, is the longest bone in the body. Periprosthetic distal femur fracture after tka usually can be operated by intramedullary nailing, plating or revision arthroplasty. The bone can break straight across transverse fracture or into many pieces comminuted fracture.
Our aim is to add to the scant literature on triplane fractures of the distal femur in the paediatric population. Distal femur lecture orthopaedic trauma association ota. Apr 07, 2016 in our series in 2 out of 3 unsuccessfully cases we used plates with a length less than 9 holes. Buckle fractures of the distal radius are one of the most common fractures of childhood and represent about 20% of all pediatric fractures4 ii. Dfn distal femoral nail surgical technique depuy synthes 5 3 determine nail length position the image intensi. The most common classification system used for distal femur fractures is the aoota system figure 3.
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