Distal Femoral Replacement for Acute Distal Femoral Fractures in Elderly Patients

Abstract

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Single-stage bilateral distal femur replacement for traumatic distal femur fractures

“…reported on a group of 18 patients treated with DFR for native distal femur fracture and had 2 complications including one femur fracture requiring revision and one early infection that was successfully treated with revision of components. In this study, all patients were either very or extremely satisfied at the average follow-up of 2.3 years [6] . Rosen and Strauss reported on 24 patients treated with DFR for primary distal femur fracture and had no complications at mean follow-up of 11 months, with 71% returning to preoperative ambulatory function [12] .…”

“…Rosen and Strauss reported on 24 patients treated with DFR for primary distal femur fracture and had no complications at mean follow-up of 11 months, with 71% returning to preoperative ambulatory function [12] . These studies concluded that DFR is a viable treatment option for elderly patients with comminuted intraarticular distal femur fractures with preexisting arthrosis that allows for immediate weight-bearing, with most patients returning to preoperative functional status at baseline [6] , [12] .…”

“…Both these fractures have similar challenges for management, which include short distal segments for fixation, osteoporotic bone, concern for extensive blood loss with exposure, and varus collapse without the support of both columns. Surgical treatment options for both these injuries are also similar and include flexible or rigid intramedullary devices, external fixators, locked plates, and distal femur replacement (DFR) [3] , [4] , [5] , [6] .…”

“…Similarly, these benefits have also been seen in the treatment of comminuted intraarticular distal femur fractures deemed not reconstructable because of inadequate bone stock to allow for open reduction internal fixation or intramedullary nail placement (AO classification 33-C2 and 33-C3 fractures) [11] , [12] . For both circumstances, DFR offers benefits of earlier mobilization, faster recovery, and not relying on bone healing which is usually compromised in these patients [2] , [6] .…”

Treatment of periprosthetic fractures of the knee using trabecular metal cones for stabilization

“…In the latter case, treatment has often involved megaprostheses with a metallic replacement of the distal femur or allograft replacement of the distal femur [4] , [8] . The disadvantage of these techniques are associated with the low level of biological reconstruction and the high risk of infection that results from the large metallic or dead bone surfaces [8] , [9] , [10] , [11] .…”