Distal femoral fracture

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: