Simplifying distal femoral fracture. All information collected from authentic sources.

1. Distal femoral fracture
Dr. Ashiqur Rahman
Resident Orthopedics
Dhaka Medical College & Hospital

4. There is three major muscle groups in thigh –
1. Adductors :
a. Adductor longus
b. Adductor Brevis
c. Adductor magnus
2. Quadriceps:
a. Vastus medialis
b. Vastus lateralis
c. Vastus lateralis
d. Rectus femoris

5. 3. Hamstring :
a. Semitendinosus
b. Semimembranosus
c. Biceps femoris

8. Operative treatment options:
1. DCS ( MIPO)/ ORIF
2. DFLP
3. DFN
4. External fixator

9. Swashbuckler approach of the distal femur
Pt. in supine position
Place a roll or triangle under the knee.
Make an incision from the mid-lateral line of the femoral shaft &
curve it anteriorly from above the fracture laterally to across the
patella.
Extend the incision directly down to the fascia of the quadriceps.
Incise the quadriceps fascia in line with the skin incision.
Sharply dissect the quadriceps fascia off the vastus lateralis & retract
along with the iliotibial band laterally.

10. Incise the lateral para-patellar retinaculum, separating it from the
vastus lateralis.
Make a lateral parapatellar arthrotomy to expose the femoral
condyles.
Place a retractor under the vastus lateralis and medialis, exposing the
distal femur and displacing the patella medially.
Ligate the perforating vessels and elevate the vastus lateralis,
exposing the entire distal femur.
Proceed with the internal fixation as needed.
Close the wound by suturing the fascia back in place.

11. Retrograde intramedullary nailing with DFN technique:
1. Supine position in a radiolucent table
2. Knee Is flexed to 70-90 degree
3. Medial para-patellar incision
4. Entry point of the nail is in the axis of the medullary canal
5. Just below the crest of the intercondylar notch.
6. Less anterior and lateral to the proximal attachment of the PCL
7. Final position of the nail should be 2-5 mm behind the articular
cartilage