Skip to main content

Advertisement

SpringerLink
Log in

Distal femur fractures management and evolution in the last century

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this historical review is to illustrate the progression and evolution of treatment for distal femur fractures.

Methods

Scientific literature was searched for descriptions of treatment for distal femur fractures to provide an in-depth overview of the topic, with emphasis on the evolution of surgical constructs used to treat these fractures.

Results

Prior to the 1950s, distal femur fractures were treated nonoperatively, resulting in considerable morbidity, limb deformity, and limited function. As principles of surgical intervention for fractures emerged in the 1950s, surgeons developed conventional straight plates to better stabilize distal femur fractures. Angle blade plates and dynamic condylar screws emerged out of this scaffolding to prevent post-treatment varus collapse. Meanwhile, intramedullary nails, and later, in the 1990s, locking screws, were introduced to minimize soft tissue disruption. Treatment failure led to the development of locking compression plates with the advantage of accommodating either locking or nonlocking screws. Despite this advancement, the rare but significant incidence of nonunion has not been eliminated, leading to the recognition of the biomechanical environment as important for prevention and the development of active plating techniques.

Conclusion

Emphasis for the surgical treatment of distal femur fractures has incrementally progressed over time, with initial focus on complete stabilization of the fracture while the biological environment surrounding the fracture was ignored. Techniques slowly evolved to minimize soft tissue disruption, allow more ease of implant placement at the fracture site, and attend to the systemic health of the patient, while simultaneously ensuring appropriate fracture fixation. Through this dynamic process, the desired results of complete fracture healing and maximization of functional outcomes have emerged.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Data availability

All data and materials support our published claims and comply with field standards.

Code availability

Not applicable.

References

  1. Gwathmey FW Jr, Jones-Quaidoo SM, Kahler D, Hurwitz S, Cui Q (2010) Distal femoral fractures: current concepts. J Am Acad Orthop Surg 18(10):597–607. https://doi.org/10.5435/00124635-201010000-00003

    Article  PubMed  Google Scholar 

  2. Martinet O, Cordey J, Harder Y, Maier A, Bühler M, Barraud GE (2000) The epidemiology of fractures of the distal femur. Injury 31(Suppl 3):C62–C63. https://doi.org/10.1016/s0020-1383(00)80034-0

    Article  PubMed  Google Scholar 

  3. Sanders R, Swiontkowski M, Rosen H, Helfet D (1991) Double-plating of comminuted, unstable fractures of the distal part of the femur. J Bone Joint Surg Am 73(3):341–346

    Article  CAS  PubMed  Google Scholar 

  4. Mast J, Jakob R, Ganz R (1989) Planning and reduction technique in fracture surgery. Springer-Verlag, Berlin

    Book  Google Scholar 

  5. Prayson MJ, Datta DK, Marshall MP (2001) Mechanical comparison of endosteal substitution and lateral plate fixation in supracondylar fractures of the femur. J Orthop Trauma 15(2):96–100. https://doi.org/10.1097/00005131-200102000-00004

    Article  CAS  PubMed  Google Scholar 

  6. Sain A, Sharma V, Farooque K, Muthukumaran V, Pattabiraman K (2019) Dual plating of the distal femur: indications and surgical techniques. Cureus 11(12):e6483. https://doi.org/10.7759/cureus.6483

    Article  PubMed  PubMed Central  Google Scholar 

  7. Imam MA, Torieh A, Matthana A (2018) Double plating of intra-articular multifragmentary C3-type distal femoral fractures through the anterior approach. Eur J Orthop Surg Traumatol 28(1):121–130. https://doi.org/10.1007/s00590-017-2014-9

    Article  PubMed  Google Scholar 

  8. Yang RS, Liu HC, Liu TK (1990) Supracondylar fractures of the femur. J Trauma 30(3):315–319. https://doi.org/10.1097/00005373-199003000-00009

    Article  CAS  PubMed  Google Scholar 

  9. Schatzker J, Mahomed N, Schiffman K, Kellam J (1989) Dynamic condylar screw: a new device. A preliminary report. J Orthop Trauma 3(2):124–132. https://doi.org/10.1097/00005131-198906000-00007

    Article  CAS  PubMed  Google Scholar 

  10. Sanders R, Regazzoni P, Ruedi TP (1989) Treatment of supracondylar-intracondylar fractures of the femur using the dynamic condylar screw. J Orthop Trauma 3(3):214–222. https://doi.org/10.1097/00005131-198909000-00006

    Article  CAS  PubMed  Google Scholar 

  11. Practice of Intramedulllary Nailing (1967) Translated by Rinne. Sprinfield, IL

  12. Butler MS, Brumback RJ, Ellison TS, Poka A, Bathon GH, Burgess AR (1991) Interlocking intramedullary nailing for ipsilateral fractures of the femoral shaft and distal part of the femur. J Bone Joint Surg Am 73(10):1492–1502

    Article  CAS  PubMed  Google Scholar 

  13. Leung KS, Shen WY, So WS, Mui LT, Grosse A (1991) Interlocking intramedullary nailing for supracondylar and intercondylar fractures of the distal part of the femur. Bone Joint Surg Am 73(3):332–340

    Article  CAS  Google Scholar 

  14. Domínguez I, Moro Rodriguez E, De Pedro Moro JA, Cebrian Parra JL, López-Durán Stern L (1998) Antegrade nailing for fractures of the distal femur. Clin Orthop Relat Res 350:74–79

    Google Scholar 

  15. Lucas SE, Seligson D, Henry SL (1993) Intramedullary supracondylar nailing of femoral fractures. A preliminary report of the GSH supracondylar nail. Clin Orthop Relat Res 296:200–206

    Article  Google Scholar 

  16. Danziger MB, Caucci D, Zecher SB, Segal D, Covall DJ (1995) Treatment of intercondylar and supracondylar distal femur fractures using the GSH supracondylar nail. Am J Orthop (Belle Mead NJ) 24(9):684–690

    CAS  PubMed  Google Scholar 

  17. Iannacone WM, Bennett FS, DeLong WG Jr, Born CT, Dalsey RM (1994) Initial experience with the treatment of supracondylar femoral fractures using the supracondylar intramedullary nail: a preliminary report. J Orthop Trauma 8(4):322–327. https://doi.org/10.1097/00005131-199408000-00008

    Article  CAS  PubMed  Google Scholar 

  18. Janzing HM, Stockman B, Van Damme G, Rommens P, Broos PL (1998) The retrograde intramedullary nail: prospective experience in patients older than sixty-five years. J Orthop Trauma 12(5):330–333. https://doi.org/10.1097/00005131-199806000-00006

    Article  CAS  PubMed  Google Scholar 

  19. Ingman AM (2002) Retrograde intramedullary nailing of supracondylar femoral fractures: design and development of a new implant. Injury 33(8):707–712. https://doi.org/10.1016/s0020-1383(02)00019-0

    Article  CAS  PubMed  Google Scholar 

  20. Bolhofner BR, Carmen B, Clifford P (1996) The results of open reduction and Internal fixation of distal femur fractures using a biologic (indirect) reduction technique. J Orthop Trauma 10(6):372–377. https://doi.org/10.1097/00005131-199608000-00002

    Article  CAS  PubMed  Google Scholar 

  21. Farouk O, Krettek C, Miclau T, Schandelmaier P, Guy P, Tscherne H (1999) Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? J Orthop Trauma 13(6):401–406. https://doi.org/10.1097/00005131-199908000-00002

    Article  CAS  PubMed  Google Scholar 

  22. Schütz M, Südkamp NP (2003) Revolution in plate osteosynthesis: new internal fixator systems. J Orthop Sci 8(2):252–258. https://doi.org/10.1007/s007760300044

    Article  PubMed  Google Scholar 

  23. Haas N, Hauke C, Schütz M, Kääb M, Perren SM (2001) Treatment of diaphyseal fractures of the forearm using the point contact fixator (PC-Fix): results of 387 fractures of a prospective multicentric study (PC-Fix II). Injury 32(Suppl 2):B51–B62. https://doi.org/10.1016/s0020-1383(01)00126-7

    Article  PubMed  Google Scholar 

  24. FernándezDell’Oca AA, Tepic S, Frigg R, Meisser A, Haas N, Perren SM (2001) Treating forearm fractures using an internal fixator: a prospective study. Clin Orthop Relat Res 389:196–205. https://doi.org/10.1097/00003086-200108000-00028

    Article  Google Scholar 

  25. Leung F, Chow SP (2003) A prospective, randomized trial comparing the limited contact dynamic compression plate with the point contact fixator for forearm fractures. J Bone Joint Surg Am 85(12):2343–2348. https://doi.org/10.2106/00004623-200312000-00011

    Article  PubMed  Google Scholar 

  26. Weight M, Collinge C (2004) Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma 18(8):503–508. https://doi.org/10.1097/00005131-200409000-00005

    Article  PubMed  Google Scholar 

  27. Kregor PJ, Stannard JA, Zlowodzki M, Cole PA (2004) Treatment of distal femur fractures using the less invasive stabilization system: surgical experience and early clinical results in 103 fractures. J Orthop Trauma 18(8):509–520. https://doi.org/10.1097/00005131-200409000-00006

    Article  PubMed  Google Scholar 

  28. Wong MK, Leung F, Chow SP (2005) Treatment of distal femoral fractures in the elderly using a less-invasive plating technique. Int Orthop 29(2):117–120. https://doi.org/10.1007/s00264-004-0609-3

    Article  PubMed  PubMed Central  Google Scholar 

  29. Smith TO, Hedges C, MacNair R, Schankat K, Wimhurst JA (2009) The clinical and radiological outcomes of the LISS plate for distal femoral fractures: a systematic review. Injury 40(10):1049–1063. https://doi.org/10.1016/j.injury.2009.01.005

    Article  CAS  PubMed  Google Scholar 

  30. Sommer C, Gautier E, Müller M, Helfet DL, Wagner M (2003) First clinical results of the locking compression plate (LCP). Injury 34(Suppl 2):B43–B54. https://doi.org/10.1016/j.injury.2003.09.024

    Article  PubMed  Google Scholar 

  31. Vallier HA, Immler W (2012) Comparison of the 95-degree angled blade plate and the locking condylar plate for the treatment of distal femoral fractures. J Orthop Trauma 26(6):327 332. https://doi.org/10.1097/BOT.0b013e318234d460

  32. Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ (2014) Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma 28(2):83–89. https://doi.org/10.1097/BOT.0b013e31829e6dd0

    Article  PubMed  Google Scholar 

  33. Rodriguez EK, Boulton C, Weaver MJ, Herder LM, Morgan JH, Chacko AT, Appleton PT, Zurakowski D, Vrahas MS (2014) Predictive factors of distal femoral fracture nonunion after lateral locked plating: a retrospective multicenter case-control study of 283 fractures. Injury 45(3):554–559. https://doi.org/10.1016/j.injury.2013.10.042

    Article  PubMed  Google Scholar 

  34. Vallier HA, Hennessey TA, Sontich JK, Patterson BM (2006) Failure of LCP condylar plate fixation in the distal part of the femur. A report of six cases. J Bone Joint Surg Am 88(4):846–853. https://doi.org/10.2106/JBJS.E.00543

    Article  PubMed  Google Scholar 

  35. Johnson EE (2006) Failure of LCP condylar plate fixation in the distal part of the femur. J Bone Joint Surg Am 88(11):2539–2542. https://doi.org/10.2106/00004623-200611000-00041

    Article  PubMed  Google Scholar 

  36. Bottlang M, Lesser M, Koerber J, Doornink J, von Rechenberg B, Augat P, Fitzpatrick DC, Madey SM, Marsh JL (2010) Far cortical locking can improve healing of fractures stabilized with locking plates. J Bone Joint Surg Am 92(7):1652–1660. https://doi.org/10.2106/JBJS.I.01111

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bottlang M, Fitzpatrick DC, Sheerin D, Kubiak E, Gellman R, VandeZandschulp C, Doornink J, Earley K, Madey SM (2014) Dynamic fixation of distal femur fractures using far cortical locking screws: a prospective observational study. J Orthop Trauma 28(4):181–188. https://doi.org/10.1097/01.bot.0000438368.44077.04

    Article  PubMed  Google Scholar 

  38. Bottlang M, Tsai S, Bliven EK, von Rechenberg B, Kindt P, Augat P, Henschel J, Fitzpatrick DC, Madey SM (2017) Dynamic stabilization of simple fractures with active plates delivers stronger healing than conventional compression plating. J Orthop Trauma 31(2):71–77. https://doi.org/10.1097/BOT.0000000000000732

    Article  PubMed  Google Scholar 

  39. Kidiyoor B, Kilaru P, Rachakonda KR, Joseph VM, Subramaniam GV, Sankineani SR, Nugur A, Gurava Reddy AV (2019) Clinical outcomes in periarticular knee fractures with flexible fixation using far cortical locking screws in locking plate: a prospective study. Musculoskelet Surg 103(2):149–153. https://doi.org/10.1007/s12306-018-0553-9

    Article  CAS  PubMed  Google Scholar 

  40. Gardner MJ, Nork SE, Huber P, Krieg JC (2009) Stiffness modulation of locking plate constructs using near cortical slotted holes: a preliminary study. J Orthop Trauma 23(4):281–287. https://doi.org/10.1097/BOT.0b013e31819df775

    Article  PubMed  Google Scholar 

  41. Linn MS, McAndrew CM, Prusaczyk B, Brimmo O, Ricci WM, Gardner MJ (2015) Dynamic locked plating of distal femur fractures. J Orthop Trauma 29(10):447–450. https://doi.org/10.1097/BOT.0000000000000315

    Article  PubMed  Google Scholar 

  42. Bottlang M, Tsai S, Bliven EK, von Rechenberg B, Klein K, Augat P, Henschel J, Fitzpatrick DC, Madey SM (2016) Dynamic stabilization with active locking plates delivers faster, stronger, and more symmetric fracture-healing. J Bone Joint Surg Am 98(6):466–474. https://doi.org/10.2106/JBJS.O.00705

    Article  PubMed  PubMed Central  Google Scholar 

  43. Giannoudis PV, Giannoudis VP (2017) Far cortical locking and active plating concepts: new revolutions of fracture fixation in the waiting? Injury 48(12):2615–2618. https://doi.org/10.1016/j.injury.2017.11.030

    Article  PubMed  Google Scholar 

  44. Wang R, Zhang H, Cui H, Fan Z, Xu K, Liu P, Ji F, Tang H (2019) Clinical effects and risk factors of far cortical locking system in the treatment of lower limb fractures. Injury 50(2):432–437. https://doi.org/10.1016/j.injury.2018.09.013

    Article  PubMed  Google Scholar 

  45. Li CS, Vannabouathong C, Sprague S, Bhandari M (2015) The use of carbon-fiber-reinforced (CFR) PEEK material in orthopedic implants: a systematic review. Clin Med Insights Arthritis Musculoskelet Disord 8:33–45. https://doi.org/10.4137/CMAMD.S20354

    Article  PubMed  PubMed Central  Google Scholar 

  46. Mitchell PM, Lee AK, Collinge CA, Ziran BH, Hartley KG, Jahangir AA (2018) Early comparative outcomes of carbon fiber-reinforced polymer plate in the fixation of distal femur fractures. J Orthop Trauma 32(8):386–390. https://doi.org/10.1097/BOT.0000000000001223

    Article  PubMed  Google Scholar 

  47. Weber BG, Čech O (1976) Pseudarthrosis: pathophysiology, biomechanics, therapy, results. Grune & Stratton. Print, New York

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Matthew Nester

  2. Department of Orthopedic and Sports Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Joseph Borrelli Jr.

Authors
  1. Matthew Nester
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Joseph Borrelli Jr.
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Literature search and data analysis were performed by Matthew Nester and Joseph Borrelli, Jr., MD, MBA. The first draft of the manuscript was written by Matthew Nester and Joseph Borrelli, Jr., MD, MBA, and all authors commented on previous versions of the manuscript. All authors read and approved of the final manuscript.

Corresponding author

Correspondence to Joseph Borrelli Jr..

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nester, M., Borrelli, J. Distal femur fractures management and evolution in the last century. International Orthopaedics (SICOT) 47, 2125–2135 (2023). https://doi.org/10.1007/s00264-023-05782-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-023-05782-1

Keywords

Search

Navigation