Distal femoral fracture
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 can occur as a domestic accident 1-3.
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 effected and the elderly women are more often affected.
Inability and pain to bear weight, swelling and bruising, deformity, or in case of a polytrauma.
- high energy trauma to the flexed knee/dashboard injury
- fall on the knee in the elderly
Plain radiographs are the mainstay of the diagnosis and the characterization of distal femoral fractures. But CT is beneficial since most of the distal femoral fractures are intraarticular 1.
MRI can help if concomitant meniscal or ligamentous injury is suspected 3.
Fractures are discontinuity of bone and will usually show a radiolucency or cortical breach. Depending on how they are displaced there will be features of overlay and/or impaction.
Ideally should be classified, a common classification is the AO classification 4.
- fracture lines and plane
- location in relation to the joint
- extraarticular, partial or complete articular
- involvement oft the condylar weight-bearing surfaces or the notch
- simple, fragmentary, multi-fragmentary
A common distal femoral condyle fracture is the Hoffa fracture.
- ligamentous or meniscal injuries
- vascular injuries (rare)
Treatment and prognosis
They will usually require open reduction and internal fixation particularly in case of displaced or intraarticular fractures 1-3.
Extraarticular or simple intraarticular fractures can be treated with intramedullary nailing and screw fixation 1.
Simple unicondylar or epicondyle fractures can be treated with simple screw fixation 1.
Very comminuted not reconstructable fractures or patients with preexisting osteoarthritis might need arthroplasty 1.
Nonoperative management is rare and considered in stable non-displaced fractures in non-ambulatory patients with unacceptable risk 1,3.
- 1. Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. (2013) Orthopaedics & traumatology, surgery & research : OTSR. 99 (3): 353-60. doi:10.1016/j.otsr.2012.10.014 - Pubmed
- 2. Crist BD, Della Rocca GJ, Murtha YM. Treatment of acute distal femur fractures. (2008) Orthopedics. 31 (7): 681-90. doi:10.3928/01477447-20110505-08 - Pubmed
- 3. Link BC, Babst R. Current concepts in fractures of the distal femur. (2012) Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 79 (1): 11-20. Pubmed
- 4. Fracture and Dislocation Classification Compendium-2018. (2018) Journal of orthopaedic trauma. 32 Suppl 1: S1-S170. doi:10.1097/BOT.0000000000001063 - Pubmed