Distal Femur Fractures

Question 1

What does a CT assist with in distal femur fractures?

Answer 1

1) Identify osteochondral fragments in the joint
2) Identify coronal shear fragments (Hoffa fracture)
3) operative planning

Question 2

What are treatment options for distal femur fractures?

Answer 2

Nondisplaced or sick: hinged knee brace and NWB for 6 weeks

Displaced: peri articulate locking plate or supracondylar IM nail

Question 3

What is the post op regimen for ORIF of distal femur fractures?

Answer 3

Toe touch or NWB for 6-8 weeks
Early ROM
Quad and hamstring strengthening

Question 4

What is the anatomical axis of the knee as well as the medial and lateral slopes of distal femur?

Answer 4

6-7 degrees of valgus (9 valgus femur, 3 varus tibia)
Medial slope 25 degrees
Lateral slope 10 degrees

Question 5

What are the various approaches used for distal femur fractures?

Answer 5

1) anterolateral- simple or non-articular; tubercle to femoral condyle, extended up shaft
2) lateral parapatellar (Swashbuckler)- articular fxs
3) medial parapatellar- complex medial condyle fx
4) medial/lateral posterior- Hoffa fxs

Question 6

What incision is made for a retrograde IM nail in the treatment of distal femur fractures?

Answer 6

medial parapatellar; can be minimal (inferior to patella) if no articular fx; extened 2-8cm proximally if joint needs to be visualized

Question 7

During ORIF of distal femur what view is important to confirm appropriate screw length?

Answer 7

Internal rotation 30 degrees for medial cortex

Externally rotation 15 degrees for lateral cortex

Question 8

During surgical treatment of the most common variation of distal femoral “Hoffa” fractures, which of the following orientations for screw fixation should be used?

Answer 8

AP screws in the lateral femoral condyle