Distal femur fractures are traumatic injuries involving the region extending from the distal metaphyseal-diaphyseal junction to the articular surface of the femoral condyles. Diagnosis is made radiographically with CT studies often required to assess for intra-articular extension. Treatment is generally operative with ORIF, intramedullary nail, or distal femur replacement depending on available bone stock, age of patient, and patient activity demands. Patella Fractures are traumatic knee injuries caused by direct trauma or rapid contracture of the quadriceps with a flexed knee that can lead to loss of the extensor mechanism. Diagnosis can be made clinically with the inability to perform a straight leg raise and confirmed with radiographs of the knee. Treatment is either immobilization or surgical fixation depending on fracture displacement and integrity of the extensor mechanism. Proximal third tibia fractures are relatively common fractures of the proximal tibial shaft that are associated with high rates of soft tissue compromise and malunion (valgus and procurvatum). Diagnosis is made with orthogonal radiographs of the tibia with CT scan often required to assess for intra-articular extension. Treatment generally consists of surgical open reduction and internal fixation (ORIF) versus intramedullary nail fixation.

1. FRACTURE OF DISTAL FEMUR, PATELLA &
PROXIMAL TIBIA
DR.CH.RAKESH SINGHA
SILCHAR MEDICAL COLLEGE & HOSPITAL

2. DISTAL FEMUR FRACTURE
• Distal femur includes both the
supracondylar and condylar
regions.
• The distal femur broadens from the
cylindrical shaft to form two curved
condyles separated by an
intercondylar groove.

3. • Distal femur fractures are traumatic
injuries involving the region
extending from the distal
metaphyseal-diaphyseal junction
to the articular surface of the
femoral condyles.
• 3-6% of femur fractures

4. SUPRACONDYLAR FRACTURE CONDYLAR FRACTURE INTERCONDYLAR FRACTURE

5. MECHANISM OF INJURY
• Distal femur fractures are the result
of axial load with a varus, valgus
or rotational force
• Young adults : High energy trauma
such as motor vehicle accident or
fall from height
• In elderly : Minor slip or fall onto a
flexed knee

6. CLINICAL FEATURES
• Pain & swelling around distal thigh
region.
• Deformity in lower thigh
• Assessment of neurovascular status
is mandatory.

7. INVESTIGATION
• Xray
- AP view
- Lateral view
• CT scan
• MRI

8. SUPRACONDYLAR FEMUR FRACTURE INTERCONDYLAR FEMUR FRACTURE

9. • CT Scan :
- To evaluating intra-articular
involvement

10. TREATMENT
A) NONOPERATIVE
• Skeletal traction with Thomas splint
• Fracture brace or plaster
application
B) OPERATIVE
• Most displaced distal femur
fractures are best treated with
operative stabilisation.
1) Screws
2) Plates
3) Intramedullary nails
4) External fixation

11. A) NONOPERATIVE
• Indication :
- Nondisplaced fracture.
- Severe osteopenia
- Advanced underlying medical
conditions.
• Skeletal traction with Thomas splint.
• Fracture brace or plaster application.

12. B) OPERATIVE
1) BLADE PLATE AND SCREW FIXATION 2) DYNAMIC CONDYLAR SCREW FIXATION

13. 3) LOCKING CONDYLAR PLATE FIXATION 4) INTRAMEDULLARY NAILING

14. UNICONDYLE FRACTURE FIXATION
• Fracture of medial condyle fixed
with
- cancellous screw

15. COMPLICATIONS
• Fixation failure
• Malunion
• Non union
• Posttraumatic osteoarthritis
• Infection
• Loss of knee motion

16. PATELLA
• The patella (knee-cap) is located at
the front of the knee joint
• It is the largest sesamoid bone in
the body.
• It’s superior aspect is attached to
the quadriceps tendon, and
inferior aspect to the patellar
ligament.

17. ANATOMY
• Its anterior surface is convex and
rough.
• Its posterior surface presents a
large articular surface split into
small medial part and large lateral
part.

18. FUNCTION OF PATELLA
1. Leg extension – It is an integral part of extensor mechanism of knee joint.
2. Protection – Protects the distal part of femur from direct trauma.
3. De-acceleration mechanism of patella help a person to de-accelerate
quickly without difficulty while running/in motion.

19. MECHANISM OF INJURY:
• Direct injury:
- Occurs in direct trauma to
patella.
-E.g. fall onto the knee or a
blow/ hit directly on the knee.
• Indirect injury:
- Occurs by a sudden violent
contraction of the quadriceps
muscle.

20. TYPES OF PATELLA FRACTURE

21. CLINICAL FEATURES:
• Swollen and painful knee
• Abrasions and bruising
• Tenderness over patella
• A gap can be felt

22. AP LATERAL SKYLINE

23. TREATMENT
A) NONOPERATIVE:
-Undisplaced or minimally displaced
fractures:
-A plaster cylinder or an extensor
brace is applied

24. B) OPERATIVE:
-ORIF with TBW (Tension Band
Wiring)

25. COMPLICATIONS OF PATELLA FRACTURE
• Early
• Stiffness of knee joint
• Infection
• Late
• Post traumatic arthritis
• Malunion
• Non-union

26. PROXIMAL TIBIA FRACTURE
• The proximal end of the tibia terminates
in a broad, flat region called the tibial
plateau.
• The intercondylar eminence runs down
the midline of the plateau, separating the
medial and lateral condyles of the
tibia.

27. • Tibial plateau fractures are
periarticular injuries of the proximal
tibia frequently associated with soft
tissue injury.

28. MECHANISM OF INJURY
• Force directed medially (valgus
deformity) or laterally (varus
deformity) or both.
• Axial compressive force.
• Both axial force and force from the
side.

29. CLINICAL FEATURES
• Pain & swelling
• Unable to bear weight
• Hemarthrosis
• Compartment syndrome
• Ligament injury assessment
• Neurovascular examination is
essential, especially in high energy
trauma

30. INVESTIGATION
1) X ray
-AP view
-Lateral view

31. 2) CT with3D reconstruction
-Better visualisation.
3) MRI
- Useful for evaluating injuries
of menisci, cruciate & collateral
ligaments and soft tissue envelope.
4) Arteriography
- For any vascular injury.

32. TREATMENT
A) NON-OPERATIVE
• Indication
- Undisplaced fractures.
- Advanced Osteoporosis.
• Protected weight bearing and early
range of knee motion in a brace .

33. B) OPERATIVE
• Indications
- Unstable fracture
- Open fractures
- Compartment syndrome
- Vascular injuries

34. 1) Spanning external fixation -
- Temporary measure in
patients with high energy trauma
and limb shortening.
2) Percutaneous screws

35. 3) Plates and screws
4) Ring fixator or a Hybrid fixator

36. COMPLICATIONS
1) Infection
2) Malunion or Non union
3) Post traumatic Osteoarthritis

37. 4) Peroneal nerve injury
- Decreased sensation,
numbness, or tingling sensation.
- Foot drop (unable to hold the
foot up).
- "Slapping" gait (walking
pattern in which each step makes a
slapping noise).

38. 5) Compartment syndrome
• Compartment syndrome occurs when excessive
pressure builds up inside an enclosed muscle space in
the body.
If the intracompartmental pressure reaches 30mmHg or
greater. ( normal <10mmHg) 4 compartments of the
leg
- Anterior compartment
- Lateral compartment
- Deep posterior compartment
- Superficial posterior compartment

39. • The tough walls of fascia cannot easily expand, and
compartment pressure rises, preventing adequate blood
flow to tissues inside the compartment.
• Severe tissue damage can result, with loss of body
function or even death.
• Clinical feature includes (5P)
- Pain out of proportion
- Palor
- Paraesthesia
- Paralysis
- Pulselessness.

40. • Most people with acute
compartment syndrome require
immediate surgery ( FASCIOTOMY)
to reduce the compartment
pressure.

41. THANK YOU