Skip to main content
SpringerLink
Log in

Standards in der Versorgung distaler Femurfrakturen

Standards in the treatment of distal femoral fractures

  • Standards in der Unfallchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Hintergrund

Die insgesamt seltenen distalen Femurfrakturen betreffen vorwiegend 2 Altersgruppen: junge Erwachsene, bei denen meist Hochrasanztraumen ursächlich sind und häufig erhebliche Weichteilschäden und Zusatzverletzungen vorliegen, und Patienten >50 Jahre. Bei Letzteren liegen in der überwiegenden Zahl der Fälle Monoverletzungen nach Niedrigrasanztrauma vor.

Diagnose

Nach AO-Klassifikation (AO: Arbeitsgemeinschaft für Osteosynthesefragen) werden extraartikuläre (33A1–3), intraartikuläre monokondyläre (33B1–3) und intraartikuläre bikondyläre Frakturen des distalen Femurschafts (33C1–3) unterschieden. Bereits die klinische Symptomatik ist nahezu diagnosesichernd. Unbedingt erhoben werden müssen Pulsstatus und neurologischer Status. Insbesondere bei jungen Verletzten muss an die Möglichkeit einer Begleitverletzung gedacht werden. Die Sicherung der Diagnose ist meist mit einem konventionellen Röntgenbild in 2 Ebenen möglich.

Therapie

Distale Femurfrakturen werden in der Regel operativ versorgt – mit dringlicher Operationsindikation. Um eine definitive, übungsstabile Versorgung zu gewährleisten, kommen heutzutage meist die (winkelstabile) Platten- oder die retrograde Marknagelosteosynthese zum Einsatz. Die Nachbehandlung erfolgt mit einer Teilbelastung von 10 kg bei entsprechender Thromboseprophylaxe für mindestens 6 Wochen.

Abstract

Background

Distal femoral fractures are generally rare and two age groups are predominantly affected: young adults where high velocity trauma is mostly the cause and substantial soft tissue damage and additional injuries are present and patients older than 50 years. For the latter, the majority of cases involve isolated injuries due to low velocity trauma.

Diagnosis

According to the Arbeitsgemeinschaft für Osteosynthesefragen (AO, Working Group for Questions of Osteosynthesis) classification extra-articular (33A1-3), intra-articular monocondylar (33B1-3) and intra-articular bicondylar (33C1-3) fractures of the distal femoral shaft can be distinguished. Even the clinical symptoms alone are practically sufficient to make a safe diagnosis. It is absolutely necessary to measure the pulse status and neurological status. The possibility of accompanying injuries must be considered, especially in young victims. The diagnosis is confirmed mostly by conventional X-ray imaging in two planes.

Therapy

Distal femoral fractures are as a rule treated operatively with urgent indications for surgery. In order to guarantee a definitive treatment which is stable during exercise, fixed-angle locking plates and retrograde medullary nail osteosynthesis are currently mostly used. Follow-up treatment is carried out with partial loading of 10 kg and appropriate thrombosis prophylaxis for a minimum of 6 weeks.

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

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Butt MS, Krikler SJ, Ali MS (1996) Displaced fractures of the distal femur in elderly patients. Operative versus non-operative treatment. J Bone Joint Surg Br 78:110–114

    CAS  PubMed  Google Scholar 

  2. Carmack DB, Moed BR, Kingston C et al (2003) Identification of the optimal intercondylar starting point for retrograde femoral nailing: an anatomic study. J Trauma 55:692–695

    Article  PubMed  Google Scholar 

  3. Forster MC, Komarsamy B, Davison JN (2006) Distal femoral fractures: a review of fixation methods. Injury 37:97–108

    Article  CAS  PubMed  Google Scholar 

  4. Grass R, Biewener A, Rammelt S, Zwipp H (2002) Die retrograde Verriegelungsnagelosteosynthese distaler Femurfrakturen mit dem distalen Femurnagel DFN. Unfallchirurg 105:298–314

    Article  CAS  PubMed  Google Scholar 

  5. Grimme K, Gosling T, Pape HC et al (2004) Fraktur des medialen Femurkondylus als Komplikation bei der Entfernung eines retrograden Femurnagels. Unfallchirurg 107:532–536

    Article  CAS  PubMed  Google Scholar 

  6. Halvorson JJ, Anz A Langfitt M et al (2011) Vascular injury associated with extremity trauma: initial diagnosis and management. J Am Acad Orthop Surg 19:495–504

    PubMed  Google Scholar 

  7. Hillbricht S, Schultz AP, Parch A (2010) Distaler Oberschenkel. In: Müller-Mai C, Ekkernkamp A (Hrsg) Frakturen. Klassifikation und Behandlungsoptionen. Springer, Berlin Heidelberg New York, S 145

  8. Kanabar P, Kumar V, Owen PJ, Rushton N (2007) Less invasive stabilisation system plating for distal femoral fractures. J Orthop Surg (Hong Kong) 15:299–302

    Google Scholar 

  9. Kolmert L, Wulff K (1982) Epidemiology and treatment of distal femoral fractures in adults. Acta Orthop Scand 53:957–962

    Article  CAS  PubMed  Google Scholar 

  10. 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 18:509–520

    Article  PubMed  Google Scholar 

  11. Krettek C, Muller M, Miclau T (2001) Evolution of minimally invasive plate osteosynthesis (MIPO) in the femur. Injury [Suppl 3] 32:SC14–SC23

  12. Martinet O, Cordey J, Harder Y et al (2000) The epidemiology of fractures of the distal femur. Injury [Suppl 3] 31:C62–C63

    Google Scholar 

  13. McCloskey E (2013) Assessing fracture risk in patients with osteoporosis. Practitioner 257:19–21, 2–3

    PubMed  Google Scholar 

  14. Miclau T, Holmes W, Martin RE et al (1998) Plate osteosynthesis of the distal femur: surgical techniques and results. J South Orthop Assoc 7:161–170

    CAS  PubMed  Google Scholar 

  15. Morgan SJ, Hurley D, Agudelo JF et al (2008) Retrograde femoral nailing: an understanding of the intercondylar insertion site. J Trauma 64:151–154

    Article  PubMed  Google Scholar 

  16. Muller ME (1980) Classification and international AO-documentation of femur fractures. Unfallheilkd 83:251–259

    CAS  Google Scholar 

  17. Nork SE, Segina DN, Aflatoon K et al (2005) The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. J Bone Joint Surg Am 87:564–569

    PubMed  Google Scholar 

  18. Ojike NI, Roberts CS, Giannoudis PV (2010) Compartment syndrome of the thigh: a systematic review. Injury 41:133–136

    Article  PubMed  Google Scholar 

  19. Papadokostakis G, Papakostidis C, Dimitriou R, Giannoudis PV (2005) The role and efficacy of retrograding nailing for the treatment of diaphyseal and distal femoral fractures: a systematic review of the literature. Injury 36:813–822

    Article  CAS  PubMed  Google Scholar 

  20. Pascarella R, Bettuzzi C, Bosco G et al (2013) Results in treatment of distal femur fractures using polyaxial locking plate. Strategies Trauma Limb Reconstr Dec 21. [Epub ahead of print]

  21. Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 84:1093–1110

    Article  PubMed  Google Scholar 

  22. Schandelmaier P, Stephan C, Krettek C, Tscherne H (2000) Distale Femurfrakturen. Unfallchirurg 103:428–436

    Article  CAS  PubMed  Google Scholar 

  23. Schandelmaier P, Partenheimer A, Koenemann B et al (2001) Distal femoral fractures and LISS stabilization. Injury [Suppl 3] 32:SC55–SC63

  24. Watanabe Y, Takenaka N, Kobayashi M, Matsushita T (2013) Infra-isthmal fracture is a risk factor for nonunion after femoral nailing: a case-control study. J Orthop Sci 18:76–80

    Article  PubMed  Google Scholar 

  25. Zlowodzki M, Bhandari M, Marek DJ et al (2006) Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma 20:366–371

    Article  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. H. Neumann, S. Breer, B. Kienast, S. Fuchs, C. Jürgens und M. Faschingbauer geben an, dass kein Interessenkonflikt besteht. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigen oder des gesetzlich bestellten Betreuers vor. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, Bergedorfer Straße 10, 21033 , Hamburg, Deutschland

    H. Neumann, S. Breer, B. Kienast, S. Fuchs, C. Jürgens & M. Faschingbauer

Authors
  1. H. Neumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Breer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Kienast
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Fuchs
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Jürgens
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Faschingbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Neumann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neumann, H., Breer, S., Kienast, B. et al. Standards in der Versorgung distaler Femurfrakturen. Trauma Berufskrankh 16, 53–59 (2014). https://doi.org/10.1007/s10039-014-2070-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10039-014-2070-x

Schlüsselwörter

Keywords

Search

Navigation