Distal femoral fracture

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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

Radiographic features

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 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

• 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

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.

Complications

• osteoarthritis
• residual stiffness
• aseptic fracture nonunion
• infection

See also

• Hoffa fracture