Distal femoral fracture
Updates to Article Attributes
Distal femoral fractures - ICD-11 NC72.6Z
ICD-11 NC72.6Z
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 affected, and in the elderly, women are more often affected.
Clinical presentation
- pain on weight-bearing
- swelling and bruising
- deformity
- in the context of polytrauma
Complications
- dislocations
- ligamentous injuries or meniscal tears
- vascular injuries (rare)
Pathology
Mechanism
- high energy trauma to the flexed knee/dashboard injury
- fall on the knee in the elderly
Radiographic features
Plain radiographs remain the mainstay of diagnosis and characterisation of distal femoral fractures. However, CT is often helpful, since most distal femoral fractures are intra-articular 1.
MRI can be helpful if concomitant meniscal tears or a ligamentous injury is suspected 3.
Fractures will usually show a radiolucency or cortical breach. Depending on how they are displaced there may be features of overlay and/or impaction.
Radiology report
- fracture lines and plane
- location to the joint
- extra-articular, partial, or complete articular
- involvement of the condylar weight-bearing surfaces or the notch
- simple, fragmentary, multi-fragmentary
A common distal femoral condyle fracture is the Hoffa fracture (see Case 4).
Treatment and prognosis
Operative
They will usually require open reduction and internal fixation particularly in cases of displaced or intraarticular fractures 1-3.
Extra-articular or simple intra-articular fractures may be treated with intramedullary nailing and screw fixation 1.
Simple unicondylar or epicondyle fractures may be treated with simple screw fixation 1.
Very comminuted, non-reconstructable fractures or patients with pre-existing osteoarthritis might need arthroplasty 1.
Non-operative
Non-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 non-union
- infection
See also
-<p><strong>Distal femoral fractures</strong> - <strong>ICD-11 NC72.6Z </strong>involve the femoral condyles and the metaphyseal region and are often the result of high energy <a title="Trauma" href="/articles/trauma">trauma</a> 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>- +<p><strong>Distal femoral fractures</strong> involve the femoral condyles and the metaphyseal region and are often the result of high energy <a href="/articles/trauma">trauma</a> 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><p><strong>ICD-11 NC72.6Z</strong></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>ligamentous injuries or <a title="Meniscal tears" href="/articles/meniscal-tear">meniscal tears</a>- +<li>ligamentous injuries or <a href="/articles/meniscal-tear">meniscal tears</a>
References changed:
- 1. Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal Femur Fractures. Surgical Techniques and a Review of the Literature. Orthop Traumatol Surg Res. 2013;99(3):353-60. <a href="https://doi.org/10.1016/j.otsr.2012.10.014">doi:10.1016/j.otsr.2012.10.014</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23518071">Pubmed</a>
- 2. Crist B, Della Rocca G, Murtha Y. Treatment of Acute Distal Femur Fractures. Orthopedics. 2008;31(7):681-90. <a href="https://doi.org/10.3928/01477447-20110505-08">doi:10.3928/01477447-20110505-08</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18705562">Pubmed</a>
- 3. Link B & Babst R. Current Concepts in Fractures of the Distal Femur. Acta Chir Orthop Traumatol Cech. 2012;79(1):11-20. - <a href="https://www.ncbi.nlm.nih.gov/pubmed/22405544">Pubmed</a>
- 4. Meinberg E, Agel J, Roberts C, Karam M, Kellam J. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32 Suppl 1(1):S1-S170. <a href="https://doi.org/10.1097/BOT.0000000000001063">doi:10.1097/BOT.0000000000001063</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29256945">Pubmed</a>
- 1. Ehlinger M, Ducrot G, Adam P, Bonnomet F. Distal femur fractures. Surgical techniques and a review of the literature. (2013) Orthopaedics & traumatology, surgery & research : OTSR. 99 (3): 353-60. <a href="https://doi.org/10.1016/j.otsr.2012.10.014">doi:10.1016/j.otsr.2012.10.014</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23518071">Pubmed</a> <span class="ref_v4"></span>
- 2. Crist BD, Della Rocca GJ, Murtha YM. Treatment of acute distal femur fractures. (2008) Orthopedics. 31 (7): 681-90. <a href="https://doi.org/10.3928/01477447-20110505-08">doi:10.3928/01477447-20110505-08</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/18705562">Pubmed</a> <span class="ref_v4"></span>
- 3. Link BC, Babst R. Current concepts in fractures of the distal femur. (2012) Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca. 79 (1): 11-20. <a href="https://www.ncbi.nlm.nih.gov/pubmed/22405544">Pubmed</a> <span class="ref_v4"></span>
- 4. Fracture and Dislocation Classification Compendium-2018. (2018) Journal of orthopaedic trauma. 32 Suppl 1: S1-S170. <a href="https://doi.org/10.1097/BOT.0000000000001063">doi:10.1097/BOT.0000000000001063</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29256945">Pubmed</a> <span class="ref_v4"></span>
Unable to process the form. Check for errors and try again.