Distal femoral fracture
Updates to Article Attributes
!under construction!
Distal femoral fractures involve the femoral condyles and the metaphysal 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.
Epidemiology
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 in the elderly women are more often effected.
Clinical presentation
Unability and pain to bear weight, swelling and bruising, deformity or in case of a polytrauma.
Mechanism
high energy trauma to the flexed knee / dashboard injury
fall on the knee in the elderly
Associations
In traumatic injuries they can be associated with:
ligamentous injuryvascular injury potentially associated with increased blood lossdepending on the mechanism pelvic or lower limb fractures
Radiographic features H4
Plain radiographs are the mainstay of the diagnosis and the characterisation of distal femoral fractures. But a CT is beneficial since most of 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.
Reporting checklist 4
fracture lines and plane
location in relation to the joint
extraarticular, partial or complete articular
involvement oft the condylar weightbearing surfaces or the notch
simple, fragmentary, multi-fragmentary
A common distal femoral condyle fracture is the Hoffa fracture.
Associated injuries
dislocations
ligamentous or meniscal injuries
vascular injuries (rare)
Treatment and prognosis H4
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 a 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 with preexisting osteoarthritis might need athroplasty 1.
Nonoperative management is rare and considered in stable non-discplaced fractures in non-ambulatory patients with unacceptable risk 1,3.
Complications1:
residual stiffness
aseptic fracture nonunion
infection
See also
-<p><strong>Distal femoral fractures</strong> involve the femoral condyles and the metaphysal 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 <sup>1-3</sup>.</p><h4>Epidemiology</h4><p>They are quite rare and represent 3-6 % of all femoral fractures and less than 0,5% of all fractures <sup>1-3</sup>.</p><p>Young patients especially males are effected and in the elderly women are more often effected.</p><h4>Clinical presentation</h4><p>Unability and pain to bear weight, swelling and bruising, deformity or in case of a polytrauma.</p><h4>Mechanism</h4><ul>-<li><p>high energy trauma to the flexed knee / dashboard injury</p></li>-<li><p>fall on the knee in the elderly</p></li>-</ul><p>Associations</p><p>In traumatic injuries they can be associated with:</p><ul>-<li><p>ligamentous injury</p></li>-<li><p>vascular injury potentially associated with increased blood loss</p></li>-<li><p>depending on the mechanism pelvic or lower limb fractures</p></li>-</ul><p> </p><p>Radiographic features H4</p><p>Plain radiographs are the mainstay of the diagnosis and the characterisation of distal femoral fractures. But a CT is beneficial since most of distal femoral fractures are intraarticular <sup>1</sup>.</p><p>MRI can help if concomitant meniscal or ligamentous injury is suspected <sup>3</sup>.</p><p>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.</p><p>Ideally should be classified, a common classification is the AO classification <sup>4</sup>.</p><p>Reporting checklist<sup> 4</sup></p><ul>-<li><p>fracture lines and plane</p></li>-<li><p>location in relation to the joint</p></li>-<li><p>extraarticular, partial or complete articular</p></li>-<li><p>involvement oft the condylar weightbearing surfaces or the notch</p></li>-<li>-<p>simple, fragmentary, multi-fragmentary</p>-<p> </p>-<p>A common distal femoral condyle fracture is the Hoffa fracture.</p>- +<p>!under construction!</p><p><strong>Distal femoral fractures</strong> involve the femoral condyles and the metaphysal 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 <sup>1-3</sup>.</p><h4>Epidemiology</h4><p>They are quite rare and represent 3-6 % of all femoral fractures and less than 0,5% of all fractures <sup>1-3</sup>.</p><p>Young patients especially males are effected and in the elderly women are more often effected.</p><h4>Clinical presentation</h4><p>Unability and pain to bear weight, swelling and bruising, deformity or in case of a polytrauma.</p><h4>Mechanism</h4><ul>
- +<li>high energy trauma to the flexed knee / dashboard injury</li>
- +<li>fall on the knee in the elderly</li>
- +</ul><h4>Radiographic features</h4><p>Plain radiographs are the mainstay of the diagnosis and the characterisation of distal femoral fractures. But CT is beneficial since most of distal femoral fractures are intraarticular <sup>1</sup>.</p><p>MRI can help if concomitant meniscal or ligamentous injury is suspected <sup>3</sup>.</p><p>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.</p><p>Ideally should be classified, a common classification is the AO classification <sup>4</sup>.</p><h5>Reporting checklist</h5><ul>
- +<li>fracture lines and plane</li>
- +<li>location in relation to the joint</li>
- +<li>extraarticular, partial or complete articular</li>
- +<li>involvement oft the condylar weightbearing surfaces or the notch</li>
- +<li>simple, fragmentary, multi-fragmentary</li>
- +</ul><p>A common distal femoral condyle fracture is the <a href="/articles/hoffa-fracture">Hoffa fracture</a>.</p><h5>Associated injuries</h5><ul>
- +<li>dislocations</li>
- +<li>ligamentous or meniscal injuries</li>
- +<li>vascular injuries (rare)</li>
- +</ul><h4>Treatment and prognosis</h4><p>They will usually require open reduction and internal fixation particularly in case of displaced or intraarticular fractures <sup>1-3</sup>.</p><p>Extraarticular or simple intraarticular fractures can be treated with a intramedullary nailing and screw fixation <sup>1</sup>.</p><p>Simple unicondylar or epicondyle fractures can be treated with simple screw fixation <sup>1</sup>.</p><p>Very comminuted not reconstructable fractures or patients with with preexisting osteoarthritis might need athroplasty <sup>1</sup>.</p><p>Nonoperative management is rare and considered in stable non-discplaced fractures in non-ambulatory patients with unacceptable risk <sup>1,3</sup>.</p><h5>Complications</h5><ul>
- +<li><a href="/articles/osteoarthritis-of-the-knee">osteoarthritis</a></li>
- +<li>residual stiffness</li>
- +<li>aseptic <a href="/articles/fracture-non-union-1">fracture nonunion</a>
-</ul><p>Associated injuries</p><ul>-<li><p>dislocations</p></li>-<li><p>ligamentous or meniscal injuries</p></li>-<li><p>vascular injuries (rare)</p></li>-</ul><p>Treatment and prognosis H4</p><p>They will usually require open reduction and internal fixation particularly in case of displaced or intraarticular fractures <sup>1-3</sup>.</p><p>Extraarticular or simple intraarticular fractures can be treated with a intramedullary nailing and screw fixation <sup>1</sup>.</p><p>Simple unicondylar or epicondyle fractures can be treated with simple screw fixation <sup>1</sup>.</p><p>Very comminuted not reconstructable fractures or patients with with preexisting osteoarthritis might need athroplasty <sup>1</sup>.</p><p>Nonoperative management is rare and considered in stable non-discplaced fractures in non-ambulatory patients with unacceptable risk <sup>1,3</sup>.</p><p>Complications <sup>1</sup>:</p><ul>-<li><p>osteoarthritis</p></li>-<li><p>residual stiffness</p></li>-<li><p>aseptic nonunion</p></li>-<li><p>infection</p></li>-</ul><p> </p><p>See also</p><ul><li><p>Hoffa fracture</p></li></ul>- +<li>infection</li>
- +</ul><h4>See also</h4><ul><li><a href="/articles/hoffa-fracture">Hoffa fracture</a></li></ul>
References changed:
- 1. Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal Femur Fractures. Surgical Techniques and a Review of the Literature. Orthop Traumatol Surg Res. 2013;99(3):353-60. <a href="https://doi.org/10.1016/j.otsr.2012.10.014">doi:10.1016/j.otsr.2012.10.014</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23518071">Pubmed</a>
- 2. Crist B, Della Rocca G, Murtha Y. Treatment of Acute Distal Femur Fractures. Orthopedics. 2008;31(7):681-90. <a href="https://doi.org/10.3928/01477447-20110505-08">doi:10.3928/01477447-20110505-08</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18705562">Pubmed</a>
- 3. Link B & Babst R. Current Concepts in Fractures of the Distal Femur. Acta Chir Orthop Traumatol Cech. 2012;79(1):11-20. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22405544">Pubmed</a>
- 4. Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32 Suppl 1(1):S1-S170. <a href="https://doi.org/10.1097/BOT.0000000000001063">doi:10.1097/BOT.0000000000001063</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29256945">Pubmed</a>
Tags changed:
- distal femoral fractures
Systems changed:
- Musculoskeletal
- Trauma
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