Fractures of Distal Femur

The lower end of the Femur bone is broad and forms two curved structures that are called Condyles. The one located on the inner side is called the Medial Condyle and the one on the outer side is called the Lateral Condyle.

Supracondylar Area: Is the area that lies just above the Condyles on the shaft of the Femur
Intercondylar Area: Is the area between the two Condyles.

Fractures of the distal end of the femur are usually caused by high energy trauma like vehicular accidents.

Symptoms:

  • Pain
  • Swelling
  • Deformity
  • Inability to lift the leg and inability to walk.
  • Feeble or absent distal pulses if associated vascular injury.

Investigations:

X-rays:

X-ray of the Knee with lower-third femur in anterior-posterior view and in lateral view is advised.

CT Scan:

In badly Comminuted Fractures where a complex reconstruction is planned a 3-D CT scan may be advised.

Classification of Fractures:

Classification according to Anatomic Location:

  • Supracondylar Fractures: Fracture lie runs above the Condyles in the Supracondylar area.
  • Intercondylar Fractures: Fracture line involves the Femoral Condyle.

Classification according to involvement of the Knee Joint:

  • Extra-Articular Fractures: Not involving the articular surface of the femur.
  • Partial-Articular: Involves a part of the articular surface of the femur.
  • Complete-Articular Fractures: Involves the articular surface of the Knee completely.

Conservative Management:

Undisplaced Fractures may be treated by a plaster cast from the groin to the toes. It is generally kept for 8 weeks and after which it is replaced by a brace. X-rays are advised every 2 weeks till the Fracture heals. Consolidation of the fracture starts by about 6 weeks and Fracture completely unites by about 3 months. Knee movements are started after removal of plaster cast by about 8 weeks.

Disadvantages of Conservative Management:

  • Long duration of plaster cast is cumbersome
  • Plaster sores may occur
  • Stiffness of the Knee Joint

Surgical Management:

  • Displaced Fractures are treated by surgical management in the form of internal fixation with either screws, nails or plates & screws.
  • The surgery may be done by a minimally invasive approach or a completely open approach depending upon whether a closed reduction of the Fracture can be achieved or not.

General Protocol for Internal Fixation:

  • Supracondylar Fractures are usually treated by closed or open reduction and nailing.
  • Partial-Articular Fractures are usually treated with open reduction and screws only.
  • Complete-Articular Fractures are usually treated with open reduction and internal fixation with plate and screws.

Complications:

  • Loss of Knee Movement: This is seen more in Partial-Articular and Complete-Articular Fractures, delay in surgery and after cast immobilization.
  • Non-union or failure of the Fracture to unite: This is seen more in the Extra-Articular or Supracondylar Fractures.
  • Arthritis of the Knee Joint : Generally seen in patient with Intra-Articular Fractures with improper reduction and internal fixation.
  • Infection
  • Deep Vein Thrombosis