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Distal Femur Fracture Surgery


What is a distal femur fracture? 

The knee is the largest weightbearing joint in your body, and the distal femur (thigh bone) makes up the top part of your knee joint. Distal femur fractures most often occur during high-energy trauma in young patients and low-impact injuries in older patients.


What are the most common types of distal femur fractures? 

  • Transverse fractures – straight across the bone
  • Comminuted fractures – bone is broken into multiple pieces
  • Intra-articular fractures – extend into the weight bearing surface of the joint and disrupts the cartilage surface. These fractures are more complex and difficult to treat, and the management is largely surgical as these fractures tend to displace even in a cast.


What types of surgery treat distal femur fractures?

Surgical Treatment of distal femur fractures consists of internal fixation, with the most common methods being intramedullary nailing. Surgical procedures used for the management of distal femur fractures include:

  • External Fixation – Only used as a temporizing measure to stabilize limb length, alignment, and rotation until the soft tissue can tolerate internal fixation. Indications include open wounds, poor skin healing potential, and patients too unstable to tolerate internal surgical fixation. Complications include pin-tract infection, deep infection, loss of reduction, malunion, and knee stiffness. 
  • Open Reduction Internal Fixation – The bone fragments are first repositioned (reduced) into their normal alignment, and then they are held together with special screws and metal plates attached to the outer surface of the bone. Indications include fracture displacement, intra-articular fractures, and fractures that have gone on to nonunion.
  • Intramedullary Nailing – A specially designed metal rod is inserted into the marrow canal of the femur. The rod passes across the fracture to keep it in position. Intramedullary nail fixation has the benefit of providing a stable construct with minimal soft tissue and periosteum disruption.