Nasksmsm

1. Distal Femur Fractures
Assoc. Prof. Dr.MD.Tajul Islam
Unit Chief
Blue Unit 2
National Institute of Traumatology & Orthopaedic
Rehabilitation (NITOR)

2. Learning Objectives
• Define distal femur fractures
• Review epidemiology and mechanisms
• Understand classification systems
• Learn imaging and surgical management
• Discuss complications and rehabilitation

3. Epidemiology
• Account for ~0.4% of all fractures
• Bimodal: young (high-energy trauma) and
elderly (low-energy, osteoporotic)
• Slight female predominance in elderly

4. Mechanism of Injury
• High energy: RTA, falls from height
• Low energy: osteoporotic fractures
• Often associated with polytrauma

5. Anatomy
• Distal femur = metaphysis + condyle
• Medial and lateral condyles form knee joint
• Trochlear groove, intercondylar notch
• Popliteal vessels posteriorly

6. Blood Supply & Soft Tissue
• Supplied mainly by femoral and
popliteal arteries
• Close proximity to neurovascular bundle
• Soft tissue envelope critical for healing

7. Classification Overview
• AO/OTA classification (33):
• - 33A: Extra-articular
• - 33B: Partial articular
• - 33C: Complete articular
• Special: Hoffa (coronal plane)

8. AO/OTA 33A (Extra-articular)
• Simple or comminuted metaphyseal fracture
• Does not involve articular surface

9. AO/OTA 33B (Partial articular)
• Involves one condyle only
• May include coronal (Hoffa) fracture

10. AO/OTA 33C (Complete articular)
• Bicondylar fracture with articular involvement
• High complexity, requires CT for planning

11. AO Classification

12. • A for extra-articular
- A1: Simple
- A2: Metaphyseal wedge
- A3: Metaphyseal complex
• B for partial articular
- Lateral condyle sagital
- Medial condyle sagital
- Coronal

13. • C for intra-articular
- C1: Articular simple, metaphyseal simple
- C2: Articular simple, metaohyseal
multifragmentary
- C3: Articular multifragmentary

14. Hoffa Fracture
• Coronal plane fracture of femoral condyle
• Often missed on X-ray
• Best seen on CT scan

16. Clinical Features
• Pain, swelling, deformity
• Inability to bear weight
• Hemarthrosis common
• Assess for distal neurovascular status

17. Plain Radiographs
• AP and lateral of knee
• Must include joint above and below
• Merchant/notch view for posterior condyles

18. Notch view x-ray knee

19. CT Scan
• Essential for intra-articular fractures
• Helps define fragments and plan fixation

20. MRI (rare use)
• Rarely indicated
• Useful for ligamentous/meniscal injury
• May show occult fracture lines

21. Non-operative Management
• Indications: non-displaced, medically unfit
• Immobilization: cast or brace
• Risks: stiffness, malunion

22. Operative Principles
• Goals: restore articular surface, length,
alignment
• Stable fixation to allow early ROM
• Choice depends on fracture pattern

23. Locking Plate Fixation
• Lateral LCP most common
• Angular stability
• Minimally invasive techniques (MIPO)

25. Retrograde Intramedullary Nail
• Entry: intercondylar notch
• Indicated in simple, extra-articular
• Contraindicated in severe
comminution/articular fractures

26. Dual Plating / Hybrid Fixation
• Indicated in severe metaphyseal comminution
• Increases stability

27. Lateral Surgical Approach
• Standard for lateral plate fixation
• Good exposure of lateral condyle

31. Medial Surgical Approach
• Used for medial condyle/Hoffa fractures
• Careful dissection to protect neurovascular structures

35. Minimally Invasive (MIPO)
• Small incisions, indirect reduction
• Preserves blood supply
• Requires fluoroscopy

36. Post-operative Protocols
• Early ROM when fixation stable
• Weight-bearing delayed (6–8 weeks)
• DVT prophylaxis, wound care

37. Rehabilitation
• Quadriceps strengthening exercises
• Progressive ROM
• Full weight bearing at ~10–12 weeks

38. Complications
• Early-
1. Arterial damage- There is little chance but definite risk of arterial
damage & distal ischemia.
• Late-
1. Joint stiffness- is almost inevitable
2. Malunion- varus malunion & recurvatum is not uncommon
3. Non-union- can be avoided by minimal soft tissue damage & exposing
only those part that are required for reduction.

39. Key Takeaways
• Distal femur fractures are complex
• Classification and CT essential
• Stable fixation enables early ROM
• Complications are common and must be anticipated

40. When the knee joint is fully extended , the pull of the gastrocnemius
muscle on the one hand and of the adductor magnus muscle on the
other hand leads to genu recurvatum and shortening. With the knee
flexed approximately at 60 degree over a knee support this mal-
alignment of the distal fragments can easily be corrected. The
shortening is best approached by manual traction or with a
distractor.
Nice to know

41. Thank you all