Distal femoral fractures involve the femoral condyles and the metaphyseal region. They 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.
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Epidemiology
They are quite rare and represent ~5% (range 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.
Clinical presentation
pain on weight-bearing
swelling and bruising
deformity
in the context of polytrauma
Complications
dislocations
ligamentous injuries or meniscal tears
vascular injuries (rare)
Pathology
Mechanism
high energy trauma to the flexed knee/dashboard injury
fall on the knee in the elderly
Radiographic features
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.
Radiology report
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).
Classification
The AO classification system of distal femoral fractures is a commonly utilized system by orthopedic surgeons.
Treatment and prognosis
Operative
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
Non-operative management is rare and considered in stable non-displaced fractures in non-ambulatory patients with unacceptable risk 1,3.
Complications
residual stiffness
aseptic fracture non-union
infection
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