Distal femur #

Question 1

What are distal femur fractures?

Answer 1

• Fractures extending form distal metaphyseal-diaphyseal junction to articular surface of femoral condyles

Question 2

What causes distal femur fractures?

Answer 2

• High energy trauma - young
• Low energy trauma - old
• Osteoporosis
• malignancy
• knee replacement

Question 3

What classification is used for distal femur #?

Answer 3

OTA:33

Question 4

Describe the OTA 33 classification

Answer 4

• A: Extra-articular
• B: Partial articular
  
  • portion of the articular surface remains in continuity with shaft
  • Hoffa fragment
• C: Complete articular
  
  • articular fragment separated from shaft

Question 5

What is the Hoffa Fracture?

Answer 5

• type B #
• Fracture of posterior aspect of femoral condyles in coronal plane
• unicondylar - affecting lateral femoral condyle

Question 6

What are the clinical features of distal femur #?

Answer 6

• severe pain in distal thigh
• inability to weight bear
• swelling and ecchymosis
• +/- knee effusion
• assess for open frature
• perform full neurovascular examination

Question 7

What are the differentials for distal femur #?

Answer 7

• Tibial plateau #
• Haemarthrosis
• Tibial shaft #

Question 8

What Ix would you order?

Answer 8

• Bedside
  
  • perform ATLS protocol
• Bloods
  
  • routine
  • G&S
  • Serum calcium
  • Myeloma screen
• Imaging
  
  • AP & Lateral of knee and entire femur
  • CT if intra-articular involvement

Question 9

How would you Mx distal femur #?

Answer 9

• Conservative
  
  • skin traction
• Surgical
  
  • retrograde intramedullary nailing - proximal extra-articular #/ simple intraarticular #
  • ORIF - distal # / complex intra-articular #
  • External fixation - severe opne and comminuted #
  • Arthroplasty & distal femoral replacement - preexisting OA, un-reconstructable #