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. Schmidtbrudvig, amsc, usa, bs, mptt the distal femoral stress fracture can be very difficult to diagnose. The position of the leg at the time of the injury determines the presence. Among them, salterharris sh type ii is the most common, making up about half of growth plate fractures, whereas types iv, v, and vi rangs type vi are rare, accounting for only a few percent 3, 7. Patients were eligible if they were greater than 65 years of age with a distal femoral fracture, and if. Schutz m, muller m, krettek c, et al minimally invasive fracture stabilization of distal femoral fractures with the liss. The presence of these other injuries substantially complicates management and portends a considerably worse prognosis. Fracture reduction and stabilization order controversial 3. Even knowing the distribution of fracture types in these series may not be helpful in understanding the best treatment or the prognosis for the different fracture patterns grouped under. When this happens the bone fragments change position and become difficult to line up with a cast. The femoral neck is the most common location for a hip fracture. The decision to use a particular type of fixation device table is determined by the type of femoral prosthesis, the quality of distal femoral bone stock, extent of the distal fracture pattern.
Second, the standard implants used for other types of distal femoral fracture such as the condylar blade plate and supracondylar nails are not helpful for articular surface reduction and fixation. Distal femoral varus osteotomy for the valgus knee after. Babst department of trauma surgery, cantonal hospital lucerne, lucerne, switzerland summary this paper describes current treatment strategies of distal femoral fractures as well as their evidence based rationale. Pdf outcome of distal femoral fracture fixation with distal. Your digital gateway to expertise, education, and innovation. Distal femur thighbone fractures of the knee orthoinfo. Pdf distal femoral fractures treated by hinged total knee. Our work is a retrospective study of 17 cases of distal femur fracture colligated in the department of orthopaedic. Interpretation we found the liss for treatment of distal femoral fractures of all types to be a safe procedure with good results after careful planning and experience with this. Excluded were studies on abnormal patientfracture populations, external fixation, or cementbone graft use.
Occult distal femoral physeal injury with disruption of the. A fracture that occurs at the distal end of the femur bone, which includes the femoral condyles and the metaphysis. Articular distal femur fractures by retrograde intramedullary interlocking nailing vs distal femoral locking plate is the bonafide work done by dr. The long, straight part of the femur is called the femoral shaft. Xrays of the lower extremities demonstrated a displaced distal femoral physeal salter type 1 fracture on the left side and a nondisplaced distal femoral physeal salter type. However, the presence of a supracondylar fracture with intraarticular extension suggests that there may be an occult associated coronalplane hoffa fracture. An open fracture is when a bone breaks in such a way that bone fragments stick out through the skin or a. Femur shaft fractures broken thighbone orthoinfo aaos. Pdf distal femoral fractures treated by hinged total. 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. Distally, the lateral and medial condyles articulate with the tibial plateau of the tibia forming the. One study reported that 80% of patients 35 years of age or older with a distal femur fracture secondary to moderate trauma had evidence of. Distal femoral fractures treated by hinged total knee replacement in elderly patients.
Distal femoral locking compression plate fixation in. Thirtyeight studies with 2,829 femoral shaft fractures and 11 studies with 505 distal femur fractures were included. Other causes are low bone density and osteoporosis, which cause weakening of the bones. In the treatment of these injuries, it is important to keep in mind that pediatric femoral fractures differ from adult femoral fractures in several key respects, and these differences affect management. Current concepts in fractures of the distal femur soucasny pohled na zlomeniny dolniho konce stehenni kosti b. Extraarticular distal femur retrograde imn dont forget to reduce the fracture before placing distal interlocks. The position of the patient may be either lateral or supine depending on the surgeons preference. Complaints include vague hip, thigh, or knee pain, aching at night, increased pain with weightbearing, and swelling about the knee. 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.
Distal femur, fracture, supracondylar and intercondylar fracture, internal fixation, biomechanics. The femur, also known as the thigh bone, is the longest bone in the body. Bennett fracture dislocation fractures of the hand intraarticular fracture of the proximal end of the first metacarpal, with dorsal and lateral dislocation of the distal segment. Impaction of the femoral neck into the femoral head normal impaction greenspan 1992123302p. Neonatal distal femoral physeal fracture requiring closed. Distal femur zone from the articular surface to the metadiaphyseal junction approximately 15 cm from the articular surface. Distal femoral fractures are severe injuries which are technically challenging to treat surgically. Due to concern for a femoral neck stress fracture, the patient was instructed in a nonweightbearing gait with axillary crutches.
Pdf the distal femoral anatomy ofaustralopithecus owen. However, in large dogs, single pin fixation may be inadequate to allow early use of the limb. A recent study reported coronal plane fracture in 38. If the broken bone punctures the skin, it is called an open or compound fracture. They are typically sustained in highimpact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the distal femoral growth plate are remarkable in that they are the third most common growth plate fracture in children after wrist and ankle, yet they carry a risk of growth disturbance in up to 90% of cases. Distal femoral fractures typically manifest as severe thigh or knee pain, with an inability to bear weight on the injured extremity. The physical therapist also ordered radiographs of the pelvis and bilateral hips, which were initially interpreted as normal. An open fracture is when a bone breaks in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. Distal femur fractures can be closed meaning the skin is intact or can be open. Xrays of the lower extremities demonstrated a displaced distal femoral physeal salter type 1 fracture on the left side and a nondisplaced distal femoral physeal salter type 2 fracture on the. Comparisons are made with other hominids and a number of quadrupedal primates. The full text of this article is available in pdf format.
Do you want to use the redesigned ao sr like an app. Distal femoral angle aldfa is 8084 degrees knee is in 610 degrees of valgus. Figure 1 details the osseous anatomy of the femoral shaft. Most common symptoms of distal femur fracture include. Distal femoral fractures have been reported to account for between 4%57 and 7%95 of all femoral fractures, which in sweden corresponds to an annual incidence of 51 per million inhabitants older than 16 years. Pdf outcome of distal femoral fracture fixation with. Chapter 53 fractures of the distal femur china quad diaries.
Rajasekaran rb, jayaramaraju d, palanisami d, agraharam d, perumal r, kamal a, rajasekaran s. Immediate postoperative weeks 0 to 6 goals protect healing tissue control pain and edema obtain full knee extension restore knee flexion regain quadriceps control weight bearing toe touch weight bearing for six weeks range of motion. The authors describe a case of distal femoral physeal injury with disruption of the perichondrium in a 9yearold girl after a sledding. Outcome of distal femoral fracture fixation with distal femoral locking compression plate using mippo technique. Treatment of distal femur fractures remains clinically challenging. The incidence of femoral distal growth plate fractures is considered to be approximately 1 to 6% of all growth plate fractures. Supracondylar femoral fractures distal femoral fractures dr. Motor vehicle collisions, for example, are the number one cause of femur fractures. The distal femur is where the bone flares out like an upsidedown funnel.
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. Management of distal femur fractures in adults orthopedic clinics. We help you diagnose your distal femur case and provide detailed descriptions of how to manage this and hundreds of other. The distal femur is the area of the leg just above the knee joint. We help you diagnose your distal femur case and provide detailed descriptions of how to manage this and hundreds of other pathologies. An estimated 6% of all fractures of the femur account for the distal part of the bone 22, 32. When there is a break anywhere along this length of bone, it. The imaging evaluation of distal femoral fractures is based primarily on conventional radiographs. Initially, plain radiographs should be obtained for suspected fracture of the distal femur. Distal femur fractures in adults orthopaedics and trauma. Fractures involving the proximal femur, in particular, involving the femoral neck, have substantially different consequences and treatment options. The most common mechanism of distal femoral fracture is direct trauma to a. Left a transverse fracture across the distal femur center an intraarticular fracture that extends into the knee joint right a comminuted fracture that extends into the knee joint and upwards into the femoral shaft.
Results of a clinical study with special emphasis on difficult cases. Minimalinvasive treatment of distal femoral fractures. A femoral fracture is a bone fracture that involves the femur. The authors describe a case of distal femoral physeal injury with disruption of the perichondrium in a 9yearold girl after a sledding accident. Healing, nonunion, and reoperation after internal fixation. The incidence of distal femur fractures among all orthopedic injuries is less than. Osteoarthritis may result when there is a diastasis of 3 or more millimetres. Included studies had 20 acute, nonpathologic distal or diaphyseal femur fractures treated with primary internal fixation. Using the ao fracture classification system, group 33c3 fractures and 33c2 fractures with intraarticular displacement were generally fixed with a transarticular. Distal femoral fracture, internal fixation, distal femoral locking compression plate introduction distal femoral fractures, especially ao type c fractures are difficult to treat. In our experience, ct is extremely helpful in characterization of complex intraarticular fractures of the distal femur.
If the diaphseal and the distal femoral fractures are to be fixed using a retrograde femoral nail, and cannulated screws or dynamic hip screws should be. Distal femur fractures orthopaedic trauma association ota. One group including patients below 40 years of age, predominantly males, sustaining highenergy trauma such as traffic accident or a fall from heights. Distal locking of the femoral polyax locked plating system construct is accomplished. Dualplating of the distal femur is required in some cases to achieve stable fixation. Pdf current concepts in fractures of the distal femur. Dec 11, 2018 femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures. Fractures of the thighbone that occur just above the knee joint are called distal femur fractures. Treatment options for distal femoral fractures ncbi. Anatomy distal femur femur transitions from cylinder to condyles medial condyle extends further inferior cancellous bone trapezoidal shape what this means for fixation avoid notch and concomitant injury to cruciate ligaments avoid penetration of medial cortex with anterior screws x x deforming forces quadriceps, hamstrings shorten. Previously the trend in treatment of these fractures leaned towards closed.
Our aim was to evaluate the current effectiveness of our management of distal femoral fractures by measuring one year mortality rates amongst different treatment modalities. Distal femur fracture an overview sciencedirect topics. Distal femur fractures orthopaedic trauma association. Distal femur lecture orthopaedic trauma association. Occult distal femoral physeal injury with disruption of the perichondrium nancy chauvin, md and diego jaramillo, md, mph abstract. Dec 27, 2019 a surgical algorithm for the management of recalcitrant distal femur nonunions based on distal femoral bone stock, fracture alignment, medial void, and stability of fixation. Ipsilateral proximal, shaft and distal femoral fracture. Locking compression plate in distal femoral intraarticular. Overuse can cause stress fractures, which are very small cracks in the bone.
Download pdf bmc musculoskeletal disorders biomed central. Jul 20, 2017 when the distal femur breaks, both the hamstrings and quadriceps muscles tend to contract and shorten. Because the femur is so strong, it usually takes a lot of force to break it. Likewise, distal femoral fractures, particularly those involving the.
Intraarticular fractures of distal femur present a huge surgical challenge. Shortening of the fracture with varus and extension of the distal articular segment is the typical deformity. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter see hip fractures. Get the best in trauma literature at 2000 inr per year. Occult distal femoral physeal injury with disruption of. Obvious swelling and deformity are often present, although these findings may be less evident in the obese patient. If the guide pin is not parallel, malalignment will result, typically in the form of valgus of the distal fragment. Pipkin 3 and 4 lesions represent the combination of a type 1 or 2 femoral head fracture with either a femoral neck fracture type 3 or acetabular fracture type 4 fig 5.
Nonunions of the distal femur are inherently difficult to treat and associated with significant patient disability. Patients with distal femoral fractures do not routinely require ct. Femur fracture following acl reconstruction has been reported in isolated cases as a result of distal femoral bone defects created for extraarticular fixation of a goretex prosthetic graft, 9 a ligament augmentation device, 10 iliotibial band tenodesis, 11 doublebundle reconstruction, or femoral postfixation. Surgical repair of distal femoral physeal fractures in the. Easy and secure online payment and book delivered at your doorsteps. The patient presented with knee pain, limited range of motion. The incidence of nonunion after fractures of the distal femur is up to 6%. Regarding the epidemiology, two pikes characterize these fractures, also differentiated by age, traumatic energy and, thus, fracture aspect. Excluded were studies on abnormal patient fracture populations, external fixation, or cementbone graft use.
If in between sizes, it is best to choose the longer of the two plates. Distal femur fractures, complications, surgical management. Distal femoral stress fracture in military basic trainees. In more complex fractures, ct is used to delineate intraarticular extension, degree of comminution, and fracture lines in the coronal plane.
The aim of this study is to evaluate functional outcome, fracture healing, and the complications of distal femoral intraarticular fractures using locking compression plates. Even knowing the distribution of fracture types in these series may not be helpful in understanding the best treatment or the prognosis for the different fracture patterns grouped under the title distal femoral fracture. Fractures of the distal femur occur in a bimodal age distribution. The incidence is between 4% to 6% of femur fractures and 1% of all orthopedic trauma. Distal femur thighbone fractures of the knee orthoinfo aaos.
In addition, femoral intramedullary pins existing the trochanteric fossa have been associated with sciatic nerve injury. Pediatric femoral fractures may involve the proximal femur, the femoral shaft, or the distal femur. 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. Dear colleagues, in an attempt to expand the outreach of knowledge, we are now starting a special subscription offer for trauma international journal. Normograde pinning of distal femoral physeal fractures is less likely to induce sciatic nerve injury then retrograde pinning. Supracondylar distal femoral fractures may be classified as extraarticular, unicondylar, or bicondylar, and the fractures may have an intercondylar extension 1, 2. Fractures commonly happen because of car accidents, falls, or sports injuries. Good option for distal fracture with concomitant proximal femur fracture that will be treated with a separate device must maintain the reduction throughout procedure.
The distal femoral nonunion is a disabling disease that needs complex steps in his treatment. When there is a break anywhere along this length of bone, it is called a femoral shaft fracture. May 04, 2016 trauma international special subscription offer. Distal femoral osteotomy physical therapy protocol phase i. Supracondylar femoral fractures objectives classificationimportant for decision making. Obtain preliminary plate fixation to the distal femoral condylar fragment using one of. Femoral neck stress fracture journal of orthopaedic. Stabilization of distal femoral fractures using the liss. Right a comminuted fracture that extends into the knee joint and upwards into the femoral shaft. Pdf this paper describes current treatment strategies of distal femoral fractures as. Supracondylar femur fracture adult distal femur trauma options. Femoral neck fractures and peritrochanteric fractures are equally prevalent and make up over 90 percent of proximal femur fractures.
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