Distal femoral fracture

Last revised by Andrew Murphy on 17 Oct 2021

Distal femoral fractures involve the femoral condyles and the metaphyseal region and are often the result of high energy trauma such as motor vehicle accidents or a fall from a height. In the elderly, they may occur as a domestic accident 1-3.

ICD-11 NC72.6Z

They are quite rare and represent 3-6 % of all femoral fractures and less than 0.5% of all fractures 1-3. Young patients, especially males are affected, and in the elderly, women are more often affected.

  • pain on weight-bearing
  • swelling and bruising
  • deformity
  • in the context of polytrauma
  • dislocations
  • ligamentous injuries or meniscal tears
  • vascular injuries (rare)
  • high energy trauma to the flexed knee/dashboard injury
  • fall on the knee in the elderly

Plain radiographs remain the mainstay of diagnosis and characterization of distal femoral fractures. However, CT is often helpful, since most distal femoral fractures are intra-articular 1.

MRI can be helpful if concomitant meniscal tears or a ligamentous injury is suspected 3.

Fractures will usually show a radiolucency or cortical breach. Depending on how they are displaced there may be features of overlay and/or impaction.

  • fracture lines and plane
  • location to the joint
  • extra-articular, partial, or complete articular
  • involvement of the condylar weight-bearing surfaces or the notch
  • simple, fragmentary, multi-fragmentary

A common distal femoral condyle fracture is the Hoffa fracture (see Case 4).

The AO classification system of distal femoral fractures is a commonly utilized system by orthopedic surgeons.

They will usually require open reduction and internal fixation particularly in cases of displaced or intraarticular fractures 1-3.

Extra-articular or simple intra-articular fractures may be treated with intramedullary nailing and screw fixation 1.

Simple unicondylar or epicondyle fractures may be treated with simple screw fixation 1.

Very comminuted, non-reconstructable fractures or patients with pre-existing osteoarthritis might need arthroplasty 1.

Non-operative management is rare and considered in stable non-displaced fractures in non-ambulatory patients with unacceptable risk 1,3.

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Cases and figures

  • Figure 1: classification of extra articular fractures
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  • Figure 2: classification of partial articular fractures
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  • Figure 3: classification of complete articular fractures
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  • Case 1
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  • Case 2
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  • Case 3. pathological femur fracture
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  • Case 4. Hoffa fracture
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