Interventions for treating fractures of the distal femur in adults

Parsons, Nicholas R.; Zbaeda, M. M.; McArthur, John

doi:10.1002/14651858.cd010606.pub2

Cited by 51 publications

(40 citation statements)

References 33 publications

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“…There is consensus regarding need for surgical management of distal femoral fracture for the last 40 years due to complications like varus or valgus malunion, non-union and problems of prolonged immobilizations like deep venous thrombosis, pulmonary embolism, pressure sores, knee stiffness and functional loss. [10][11][12][13][14] Regarding optimal methods of management, there is still controversy among treating surgeons and also a uniform clinical guidelines are lacking for the reference [13][14][15][16] . In our study, mean age of the patients were 44.70 ± 18.18 (years ± SD); 67.4% patients were elderly patients with distal femur fracture following trivial trauma.…”

Section: Discussionmentioning

confidence: 99%

A study to evaluate functional outcomes of distal femur fractures

Rijal¹,

Pashupati²,

P³

et al. 2017

Int. J. Orthop. Sci.

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Purpose: Despite advances in techniques and improvements in surgical implants, treatment of distal femoral fractures remains a challenge in many situations. Debate continues around choice of implant for fixation of metaphyseal-diaphyseal fractures. In this prospective study, we had evaluated and compared clinical and radiological outcomes of distal femur fracture stabilization. Study design: We conducted interventional study on adult patients having distal femur fractures. 58 fractures were presented during study period. 12 patients were excluded due to Polytrauma (6), head injuries (2), spine injuries (2) and unwilling to participate (2). Forty six patients were evaluated at the end of study. Demographic variables, fracture pattern, mode of injury, union time, non union, and complications were recorded in proforma evaluated at the end of follow up using Pritchett outcome scores. Results: Mean age was 44.7±18.18 yrs. Fifty percent had AO 3.3C injuries. 47.8% patients underwent distal femoral locked plate fixation. 26% had open fractures. 45.7% fractures united within 6 months of surgical procedure. 32.6% patient had excellent outcome. Loss of fixation was related to pain and tendency to worse outcome according to Pritchett score. Conclusion: Stable fixation and early knee joint mobilization are important factors for good functional outcome of distal femoral fracture.

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Section: Discussionmentioning

confidence: 99%

A study to evaluate functional outcomes of distal femur fractures

Rijal¹,

Pashupati²,

P³

et al. 2017

Int. J. Orthop. Sci.

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“…In our series we did not observed any early complications, but a reduction in knee range of motion. A recent Cochrane systematic review underlined the importance of lack of important clinical studies that might guide the orthopaedic surgeon in treating adequately the distal femoral fractures (23).…”

Section: Discussionmentioning

confidence: 99%

Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

Toro

Calabrò²,

Toro³

et al. 2015

ccmbm

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Distal femoral fractures have typically a bimodal occurrence: in young people due to a high-energy trauma and in older people related to a low-energy trauma. These fractures are associated to a very high morbidity and mortality in elderly. Distal femoral fractures might be treated with plates, intramedullary nails, external fixations, and prosthesis. However, difficulties in fracture healing and the rate of complications are important clinical issues. The purpose of this retrospective review was to present our experience in treatment of distal femoral fracture in a sample of older people in order to evaluate the technical pitfalls and strategies used to face up the fractures unsuccessfully treated with locking plates. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. We considered 'unsuccessfully treated' the cases with healing problems or hardware failures. Of the 12 patients (9 females and 3 males; mean aged 68.75 ± 3.31 years) included, we observed 3 'unsuccessfully cases', 2 due to nonunions and 1 due to an early hardware failure, all treated using a condylar blade plate with a bone graft. One patient obtained a complete fracture healing after 1 year and in the other cases there was a nonunion. We observed as most common technical pitfalls: inadequate plate lengthening, fracture bridging, and number of locking screws. The use of locking plates is an emerging technique to treat these fractures but it seems more challenging than expected. In literature there is a lack of evidences about the surgical management of distal femoral fractures that is still an important challenge for the orthopaedic surgeon that has to be able to use all the fixation devices available.

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“…Retrograde nails and locking plates have shown similar outcomes and complication rates 34 and it is therefore the surgeon’s personal experience that decides which implant is most suitable in each case.…”

Section: Combination Of Implantsmentioning

confidence: 99%

The floating knee: a review on ipsilateral femoral and tibial fractures

Jm¹,

Bel

Agundez

et al. 2016

EFORT Open Reviews

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In 1975, Blake and McBryde established the concept of ‘floating knee’ to describe ipsilateral fractures of the femur and tibia.1 This combination is much more than a bone lesion; the mechanism is usually a high-energy trauma in a patient with multiple injuries and a myriad of other lesions.After initial evaluation patients should be categorised, and only stable patients should undergo immediate reduction and internal fixation with the rest receiving external fixation.Definitive internal fixation of both bones yields the best results in almost all series.Nailing of both bones is the optimal fixation when both fractures (femoral and tibial) are extra-articular.Plates are the ‘standard of care’ in cases with articular fractures.A combination of implants are required by 40% of floating knees.Associated ligamentous and meniscal lesions are common, but may be irrelevant in the case of an intra-articular fracture which gives the worst prognosis for this type of lesion.Cite this article: Muñoz Vives K, Bel J-C, Capel Agundez A, Chana Rodríguez F, Palomo Traver J, Schultz-Larsen M, Tosounidis, T. The floating knee. EFORT Open Rev 2016;1:375-382. DOI: 10.1302/2058-5241.1.000042.

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Interventions for treating fractures of the distal femur in adults

Cited by 51 publications

References 33 publications

A study to evaluate functional outcomes of distal femur fractures

A study to evaluate functional outcomes of distal femur fractures

Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

The floating knee: a review on ipsilateral femoral and tibial fractures

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