Distal femoral fracture
Updates to Article Attributes
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 canmay occur as a domestic accident 1-3.
Epidemiology
They are quite rare and represent 3-6 % of all femoral fractures and less than 0,5.5% of all fractures 1-3. Young patients, especially males are effectedaffected, and in the elderly, women are more often affected.
Clinical presentation
Inability and
- pain
to bearon weight,-bearing - swelling and bruising
, deformity, - deformity
- in the context of polytrauma
Complications
- dislocations
-
ligamentous or
in case of a polytrauma.meniscal injuries - vascular injuries (rare)
Pathology
Mechanism
- high energy trauma
toto the flexed knee/dashboard injury - fall on the knee in the elderly
Radiographic features
Plain radiographs areremain the mainstay of the diagnosis and the characterisation of distal femoral fractures. ButHowever CT is beneficialoften helpful, since most of the distal femoral fractures are intraarticularintra-articular 1.
MRI can helpbe helpful 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 willmay be features of overlay and/or impaction.
Ideally should be classified, a common classification is the AO classification 4.
Reporting checklist
Radiology report
- fracture lines and plane
- location in relation to the joint
-
extraarticularextra-articular, 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.
Associated injuries
dislocationsligamentous or meniscal injuriesvascular injuries (rare)
Treatment and prognosis
Operative
They will usually require open reduction and internal fixation particularly in case of displaced or intraarticular fractures 1-3.
ExtraarticularExtra-articular or simple intraarticularintra-articular fractures canmay be treated with intramedullary nailing and screw fixation 1.
Simple unicondylar or epicondyle fractures canmay be treated with simple screw fixation 1.
Very comminuted not reconstructable, non-reconstructable fractures or patients with preexistingpre-existing osteoarthritis might need arthroplasty 1.
Non-operative
NonoperativeNon-operative management is rare and considered in stable non-displaced fractures in non-ambulatory patients with unacceptable risk 1,3.
Complications
- osteoarthritis
- residual stiffness
- aseptic fracture
nonunionnon-union - infection
See also
-<p><strong>Distal femoral fractures </strong>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 <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>. Young patients especially males are effected and the elderly women are more often affected.</p><h4>Clinical presentation</h4><p>Inability 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>- +<p><strong>Distal femoral fractures </strong>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 <sup>1-3</sup>.</p><h4>Epidemiology</h4><p>They are quite rare and represent 3-6 % of all <a href="/articles/femoral-fractures">femoral fractures</a> and less than 0.5% of all fractures <sup>1-3</sup>. Young patients, especially males are affected, and in the elderly, women are more often affected.</p><h4>Clinical presentation</h4><ul>
- +<li>pain on weight-bearing</li>
- +<li>swelling and bruising</li>
- +<li>deformity</li>
- +<li>in the context of polytrauma</li>
- +</ul><h5>Complications</h5><ul>
- +<li>dislocations</li>
- +<li>ligamentous or meniscal injuries</li>
- +<li>vascular injuries (rare)</li>
- +</ul><h4>Pathology</h4><h5>Mechanism</h5><ul>
- +<li>high energy trauma to the flexed knee/dashboard injury</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 the 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>- +</ul><h4>Radiographic features</h4><p>Plain radiographs remain the mainstay of diagnosis and characterisation of distal femoral fractures. However CT is often helpful, since most of the distal femoral fractures are intra-articular <sup>1</sup>.</p><p>MRI can be helpful if concomitant meniscal or ligamentous injury is suspected <sup>3</sup>.</p><p>Fractures will usually show a radiolucency or cortical breach. Depending on how they are displaced there may be features of overlay and/or impaction.</p><h4>Radiology report</h4><ul>
-<li>extraarticular, partial or complete articular</li>- +<li>extra-articular, partial or complete articular</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 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 preexisting osteoarthritis might need arthroplasty <sup>1</sup>.</p><p>Nonoperative management is rare and considered in stable non-displaced fractures in non-ambulatory patients with unacceptable risk <sup>1,3</sup>.</p><h5>Complications</h5><ul>- +</ul><p>A common distal femoral condyle fracture is the <a href="/articles/hoffa-fracture">Hoffa fracture</a>.</p><h4>Treatment and prognosis</h4><h6>Operative</h6><p>They will usually require open reduction and internal fixation particularly in case of displaced or intraarticular fractures <sup>1-3</sup>.</p><p>Extra-articular or simple intra-articular fractures may be treated with intramedullary nailing and screw fixation <sup>1</sup>.</p><p>Simple unicondylar or epicondyle fractures may be treated with simple screw fixation <sup>1</sup>.</p><p>Very comminuted, non-reconstructable fractures or patients with pre-existing osteoarthritis might need arthroplasty <sup>1</sup>.</p><h6>Non-operative</h6><p>Non-operative management is rare and considered in stable non-displaced fractures in non-ambulatory patients with unacceptable risk <sup>1,3</sup>.</p><h5>Complications</h5><ul>
-<li>aseptic <a href="/articles/fracture-non-union-1">fracture nonunion</a>- +<li>aseptic <a href="/articles/fracture-non-union-1">fracture non-union</a>
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