Distal femoral fracture

Distal
femoral fracture • AO classification of distal femur fractures (illustration) - Ganzer Fall bei Radiopaedia
Murphy, A. AO classification of distal femur fractures (illustration). Case study, Radiopaedia.org. (accessed on 28 Oct 2022) https://doi.org/10.53347/rID-94056 • CC by-nc-sa 3.0 (modified)
Distal
femoral fracture Muller Type B1 associated with Segond fracture. Superior displacement of fractured lateral femoral condyle (white arrow).
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Distal
femoral fracture Muller Type B1 associated with Segond fracture. Intra-articular fracture involving lateral femoral condyle (yellow arrow). Mild effusion is also noted.
www.eurorad.org • CC by-nc-sa-4.0
Distal
femoral fracture Muller Type B1 associated with Segond fracture. Complex tear of anterior horn and body of lateral meniscus (blue circle).
www.eurorad.org • CC by-nc-sa-4.0
Distal
femoral fracture Muller Type B1 associated with Segond fracture. Oblique displaced intraarticular fracture of lateral femoral condyle extending from metaphysis up to the articular surface (green arrow). Hyperintense signals within anterior horn of lateral meniscus representing its complex tear (yellow arrow).
www.eurorad.org • CC by-nc-sa-4.0
Distal
femoral fracture Muller Type B1 associated with Segond fracture. Slightly angulated radiograph nicely depicts classical tiny elliptic bone fragment parallel to the lateral aspect of the tibial plateau representing Segond fracture (white square) and Muller Type B1 distal femoral fracture.
www.eurorad.org • CC by-nc-sa-4.0
Distal
femoral fracture • Distal femoral fracture associated with lipohemarthrosis - Ganzer Fall bei Radiopaedia
Hosn, S. Distal femoral fracture associated with lipohemarthrosis. Case study, Radiopaedia.org. (accessed on 28 Oct 2022) https://doi.org/10.53347/rID-22158 • CC by-nc-sa 3.0 (modified)
Distal
femoral fracture Muller Type B1 associated with Segond fracture. Partial intra-articular fracture (black arrows) of lateral femoral condyle with its marked superior displacement (single white arrow) - Muller Type B1 fracture. Suspected avulsion of lateral tibial plateau (white circle).
www.eurorad.org • CC by-nc-sa-4.0
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Distal femoral fractures involve the femoral condyles and the metaphyseal 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 may occur as a domestic accident .

Epidemiology

They are quite rare and represent 3-6 % of all femoral fractures and less than 0.5% of all fractures . 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 or meniscal injuries
  • 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 characterization of distal femoral fractures. However CT is often helpful, since most distal femoral fractures are intra-articular .

MRI can be helpful if concomitant meniscal or ligamentous injury is suspected .

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 in relation 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.

Treatment and prognosis

Operative

They will usually require open reduction and internal fixation particularly in case of displaced or intraarticular fractures .

Extra-articular or simple intra-articular fractures may be treated with intramedullary nailing and screw fixation .

Simple unicondylar or epicondyle fractures may be treated with simple screw fixation .

Very comminuted, non-reconstructable fractures or patients with pre-existing osteoarthritis might need arthroplasty .

Non-operative

Non-operative management is rare and considered in stable non-displaced fractures in non-ambulatory patients with unacceptable risk .

Complications

See also

Siehe auch:
Assoziationen und Differentialdiagnosen zu distale Femurfrakturen: