“A Modified Anterolateral Swashbuckler Approach for Distal Femoral Fractures: Description and Outcomes”

Abstract

Background: The treatment of distal femur fractures represents a challenging task. General and local factors, including bone quality, articular surface involvement, fracture comminution, associated soft tissue injuries and ultimately fixation system, all play a role in the final clinical outcome. Current surgical approaches often undermine patellar vascularization and integrity of the extensor apparatus, not guaranteeing sufficient visualization of the medial condyle. This technical note presents the efficacy and safety a new surgical technique to address distal femoral fractures. Methods: The original "swashbuckler" surgical approach was modified in order to obtain a better visualization of the lateral and medial femoral condyles without affecting the knee extensor mechanism and the anastomotic arterial supply of the patella. This modified surgical approach was utilized in a consecutive series of patients presenting with a Müller AO 33 distal femur or periprosthetic fracture of the knee. The final outcome was recorded according to a functional evaluation scoring system.Results: Twelve patients (2 males and 10 females) with a mean age of 67,8 years (min. 18; max 90 years) were included in this series. The same, modified "swashbuckler" surgical approach was applied in all cases. Multiple internal fixation techniques, including a single lateral plate, a combination of a lateral and medial plate, a single lateral plate associated with lag screws, were used to obtain a satisfactory stabilization of the fracture site. All patients were reviewed at a minimum one-year follow up (median 15 months): all patients regained their level of activities of daily living. No major intraoperative or postoperative complications were recorded. Conclusions: The modified swashbuckler approach allows anatomical reduction and appropriate fixation with minimal severance of the blood supply to the patella and ensures rapid weight bearing resumption thanks to an intact extensor mechanism.

Swashbuckler approach for distal femur fractures: A systematic review

“…14 Distal femur fractures especially the AO type C with intraarticular involvement are often associated with difficulty in treating and obtaining an adequate reduction. 6,15,24 The need for anatomical reduction of the intraarticular fragments is of paramount importance as untreated cases land up in post-traumatic arthritis. 21 The lateral/lateral parapatellar approach in the distal femur often needs extensive tissue dissection and at times the intraarticular reductions are not proper.…”

“…Using the former approach often helps in limiting the use of medial parapatellar arthrotomy needed along with the lateral approach in cases of medial communication. 9,24 The review has limitations. The main limitation was that there were very few studies in the literature that evaluated the use of the swashbuckler approach.…”