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Treatment of distal femoral fractures
Kim HolckMD, consultant
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Demographics
6 % of all femoral fractures
10 % of the numbers from proximal femoral fractures
Approx 1 in 10.000 inhabitants
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Demographics
Bimodal distribution:
Male 15-50 years Female >60 years
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Extra-articular
Simple intra-articular
Complex intra-articular
AO-classification
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Classification
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Deforming forces
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Deforming forces
Shortening: Quadriceps and Hamstrings
Varus: Hip adductors
Extension: Gastrocnemius
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Conservative treatment:
Undisplaced fractures
=> only 30% do well
Treatment options
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
External fixation
Damage-control
orthopaedics
Treatment options
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Plate fixation vs. IM nailing
Treatment options
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Plate fixation vs. IM nailing
24 % secundary procedures (mainly removal)
5 % non-union
3 % fixation failure
1 % infection
Treatment options
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
What do we know
No randomised series have demonstrated
difference between retrograde nailing and
locked plates
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Position of plate
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Position of plate
Remember the
trapezoidal shape
of distal femur
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Traditional
Technique
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Traditional
Technique
PD Dr. M. Schütz (Charité)
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Fracture table
Technique
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Fracture table
Technique
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Fracture table
Technique
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Hoffa Fracture (B3)
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
Type C3 fractures (OMG)
Department of Orthopaedics Copenhagen University Hospital of Hvidovre
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