Skip to main content
SpringerLink
Log in

Distal Femoral Fractures

  • Chapter
Traumatic Disorders of the Knee

Abstract

Fractures of the distal femur constitute a heterogenous group of injuries affecting the knee. Many reports in the past have included fractures in the distal one third of the femur, thereby mixing diaphyseal, metaphyseal, and intraarticular fractures in the same series. Even knowing the distribution of fracture types in these series may not be helpful in understanding the best treatment or the prognosis for the different fracture patterns grouped under the title distal femoral fracture. In addition to a wide variety of fracture patterns, fractures of the distal femur commonly have associated injuries such as open wounds, patellar fractures, and ligament disruption. High-energy injuries tend to occur in young males, and low-energy injuries in elderly females. After consideration these factors, fractures of the distal femur must be considered a diverse group of injuries requiring thoughtful evaluation and a variety of treatments for optimal outcome. Although in the past these fractures were treated primarily by nonoperative methods, the current trend is to operate on most of these injuries. This chapter reviews the anatomy, classification, evaluation, associated injuries, treatment, and results of this group of fractures.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

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

    Article  PubMed  CAS  Google Scholar 

  2. Regazzoni P, Leutenegger A, Ruedi T, Staehelin F. Erste erfahrungen mit der dynamishen kondylenschraube (dcs) bei distalen femurfrakturen. Helv Chir Acta. 1986;53:61–64.

    PubMed  CAS  Google Scholar 

  3. Arneson TJ, Melton LJ III, Lewallen DG, O’Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965–1984. Clin Orthop. 1988;234:188–1894.

    PubMed  Google Scholar 

  4. Siliski JM, Mahring M, Hofer HP. Supracondylar-intercondylar fractures of the femur. Treatment by internal fixation. J Bone Joint Surg Am. 1989;71:94–104.

    Google Scholar 

  5. Neer CS II, Grantham SJ, Shelton ML. Supracondylar fracture of the adult femur. J Bone Joint Am. 1967;49:591–613.

    Google Scholar 

  6. Seinsheimer F. Fractures of the distal femur. Clin Orthop. 1980;153:169–179.

    PubMed  Google Scholar 

  7. Müller ME, Nazarian S, Koch P, Schatzker J. The Comprehensive Classification of Fractures of Long Bones. Berlin/Heidelberg: Springer-Verlag; 1990.

    Book  Google Scholar 

  8. Walling AK, Seradge H, Spiegel PG. Injuries to the knee ligaments with fractures of the femur. J Bone Joint Surg Am. 1982;64:1324–1327.

    PubMed  CAS  Google Scholar 

  9. Peltier LF. A brief history of traction. J Bone Joint Surg Am. 1972;54:1015–1032.

    Google Scholar 

  10. Thomas HO. The Treatment of Deformities, Fractures and Diseases of Bones in the Lower Extremities. London: HK Lewis; 1890.

    Google Scholar 

  11. Buck G. An improved method of treating fractures of the thigh illustrated by cases and a drawing. Trans NY Acad Med. 1961;2:232–250.

    Google Scholar 

  12. Russell RH. Theory and method of extension of the thigh. Br Med J. 1921;2:637–638.

    Article  Google Scholar 

  13. Steinmann FR. Eine neve extensionsmethode in der Frakturenbehandlung. Zentralbl Chir. 1907;34:938–942.

    Google Scholar 

  14. Kirschner M. Ueber nagelextension. Beitr Klin Chir. 1909;64:266–279.

    Google Scholar 

  15. Mahorner HR, Bradburn M. Fractures of the femur. Report of 308 cases. Surg Gynecol Obstet. 1933;56:1066–1079.

    Google Scholar 

  16. Tees JD. Fracture of the lower end of the femur. Am J Surg. 1937;38:656–659.

    Article  Google Scholar 

  17. Modlin J. Double skeletal traction in battle fractures of the lower femur. Bull US Army Med Dept. 1945;4:119–120.

    Google Scholar 

  18. Hampton OP. Wounds of the Extremities in Military Surgery. St. Louis: CV Mosby; 1951.

    Google Scholar 

  19. Wiggins HE. Vertical traction in open fractures of the femur. US Armed Forces Med J. 1953;4:1633–1636.

    Google Scholar 

  20. Watson-Jones R. Fractures and Joint Injuries. 4th ed. Baltimore: Williams & Wilkins; 1956.

    Google Scholar 

  21. Bohler L. Treatment of Fractures. New York: Grune and Stratton; 1956

    Google Scholar 

  22. Charnley J. The Closed Treatment of Common Fractures. 3rd ed. Edinburgh: E & S Livingstone; 1961.

    Google Scholar 

  23. Smillie IS. Injuries of the Knee Joints. 4th ed. Baltimore: Williams & Wilkins; 1971.

    Google Scholar 

  24. Stewart MJ, Sisk TD, Wallace SL. Fractures of the distal third of the femur. J Bone Joint Surg Am. 1966;48:784–807.

    Google Scholar 

  25. Borgan D, Sprague BL. Treatment of distal femur fractures with early weight bearing. Clin Orthop. 1975;111:156–162.

    Article  Google Scholar 

  26. Connolly JF, Dehne E. Closed reduction and early cast-brace ambulation in the treatment of femoral fractures. J Bone Joint Surg Am. 1973;55:1581–1599.

    PubMed  CAS  Google Scholar 

  27. Connolly JF. Closed management of distal femoral fractures. Instr Course Lect. 1987;36:428–437.

    PubMed  CAS  Google Scholar 

  28. Moll J. The cast brace walking treatment of open and closed femur fractures. South Med J. 1973;66:345–352.

    Article  PubMed  CAS  Google Scholar 

  29. Mooney V. Fractures of the distal femur. Instr Course Lect. 1987;36:427.

    PubMed  CAS  Google Scholar 

  30. Rockwood CA Jr, Ryan VL, Richards JA. Experience with quadrilateral cast brace. J Bone Joint Surg Am. 1973;55:421. Abstract.

    Google Scholar 

  31. Unmansky AL. Blade-plate internal fixation for fracture of the distal end of the femur. Bull Hosp Joint Dis. 1948;9:18–21.

    Google Scholar 

  32. Altenberg AR, Shorkey RL. Blade-plate fixation in nonunion and in complicated fractures of the supracondylar region of the femur. J Bone Joint Surg Am. 1949;31:312–316.

    Google Scholar 

  33. White EH, Russin LA. Supracondylar fractures of the femur treated by internal fixation with immediate knee motion. Am J Surg 1956;22:801–820.

    Google Scholar 

  34. Rush LV, Gelbke H. Atlas der intramedullaren frakturfixation nach Rush. Munich: JA Barth; 1957.

    Google Scholar 

  35. Wertzberger JJ, Peltier LF. Supracondylar fractures. Kans Med Soc. 1967;68:328–332.

    CAS  Google Scholar 

  36. Rush LV. Dynamic intramedullary fracture fixation of the femur. Clin Orthop. 1968;60:21–27.

    PubMed  CAS  Google Scholar 

  37. Shelbourne KD, Brueckmann FR. Rush-pin fixation of supracondylar and intercondylar fractures of the femur. J Bone Joint Surg Am. 1982;64:161–169.

    PubMed  CAS  Google Scholar 

  38. Zickle RE, Fietti VG Jr, Lawsing JF III, Cochran GV. A new intramedullary fixation device for the distal third of the femur. Clin Orthop. 1977;125:185–191.

    Google Scholar 

  39. Zickle RE, Hobeika P, Robbins DS. Zickle supracondylar nails for fractures of the distal end of the femur. Clin Orthop. 1986;212:79–88.

    Google Scholar 

  40. Zickle RE. Nonunions of fractures of the proximal and distal thirds of the shaft of the femur. Instr Course Lect. 1988;37:173–179.

    Google Scholar 

  41. Müller ME, Allgower M, Wilenegger H. Technique of Internal Fixation of Fractures. Berlin: Springer-Verlag; 1965.

    Google Scholar 

  42. Neff G. Zur Behandlung der Supracondylaren und tiefen oberschenkelfrakturen. Monatsschr Unfallheilk. 1966;69:151–159.

    CAS  Google Scholar 

  43. Olerud S. Operative treatment of supracondylar-condylar fractures of the femur. Technique and results in fifteen cases. J Bone Joint Surg Am. 1972;54:1015–1032.

    PubMed  CAS  Google Scholar 

  44. Wenzl H, Casey PA, Herbert P, Belin J. Die operative behandlung der distalen Femurfraktur. AO Bull. Dec 1970.

    Google Scholar 

  45. Slatis P, Ryoppy S, Huttinen V. AO osteosynthesis of fractures of the distal third of the femur. Acta Orthop Scand. 1971;42:162–172.

    Article  PubMed  CAS  Google Scholar 

  46. Olerud S. Reconstruktion av distala femur vid komminut frakur. Svensk Kir For Forh. 1966;24:93–94.

    Google Scholar 

  47. Chiron HS, Tremoulet J, Casey P, Muller M. Fractures of the distal third of the femur treated by internal fixation. Clin Orthop. 1974;100:160–170.

    PubMed  Google Scholar 

  48. Tscherne H, Ostern HJ, Trentz O. Spatergebnisse der distalen femurfraktur und irhe besonderen probleme. Zentralbl Chir. 1977;102:897–904.

    PubMed  CAS  Google Scholar 

  49. Schatzker J, Home G, Waddell J. The Toronto experience with the supracondylar fracture of the femur, 1966–1977. Injury. 1975;6:113–128.

    Article  Google Scholar 

  50. Schatzker J, Lambert DC. Supracondylar fractures of the femur. Clin Orthop. 1979;138:77–83.

    PubMed  Google Scholar 

  51. Della Torre P, Aglietti P, Altissimi M. Results of rigid fixation of 54 supracondylar fractures of the femur. Arch Orthop Traumat Surg. 1980;97:177–183.

    Article  CAS  Google Scholar 

  52. Mize RD, Bucholz RW, Grogan DP. Surgical treatment of displaced, comminuted fractures of the distal end of the femur. J Bone Joint Surg Am. 1982;64:871–879.

    PubMed  CAS  Google Scholar 

  53. Healy WL, Brooker AF. Distal femoral fractures. Comparison of open and closed methods of treatment. Clin Orthop. 1983;174:166–171.

    PubMed  Google Scholar 

  54. Schatzker J, Tile M. The Rationale of Operative Fracture Care. New York: Springer-Verlag; 1987.

    Google Scholar 

  55. Johnson KD. Internal fixation of distal femoral fractures. Instr Course Lect. 1989;38:437–448.

    Google Scholar 

  56. Wade PA, Okinara AJ. The problem of the supracondylar fracture of the femur in the aged person. Am J Surg. 1959;97:499–512.

    Article  PubMed  CAS  Google Scholar 

  57. Brown A, D’Arcy JC. Internal fixation for supracondylar fractures of the femur in the elderly patient. J Bone Joint Surg Br. 1971;53:420–424.

    PubMed  CAS  Google Scholar 

  58. Benum P. The use of bone cement as an adjunct to internal fixation of supracondylar fractures of osteoporotic femurs. Acta Orthop Scand. 1977;48:52–56.

    Article  PubMed  CAS  Google Scholar 

  59. Johnson EE. Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur. Clin Orthop. 1988;231:154–162.

    PubMed  Google Scholar 

  60. Mast J, Jakob R, Ganz R. Planning and Reduction Techniques in Fracture Surgery. New York: Springer-Verlag; 1989

    Book  Google Scholar 

  61. Hall MF. Two-plane fixation of acute supracondylar and intracondylar fractures of the femur. South Med J. 1978;71:1474–1479.

    Article  PubMed  CAS  Google Scholar 

  62. Giles JB, DeLee JC, Heckman JD, Keever JE. Supracondylar-intercondylar fractures of the femur treated with a supracondylar plate and lag screw. J Bone Joint Surg Am. 64:864–870.

    Google Scholar 

  63. Pritchett JW. Supracondylar fractures of the femur. Clin Orthop. 1984;184:173–177.

    PubMed  Google Scholar 

  64. Schatzker J, Mahomed N, Schiffman K, Kellam J. Dynamic condylar screw. A new device. J Orthop Trauma. 1989;3:124–132.

    Article  PubMed  CAS  Google Scholar 

  65. Sanders R, Regazzoni P, Reudi T. Treatment of supracondylar-intraarticular fractures of the femur using the dynamic condylar screw. J Orthop Trauma. 1989;3:214–222.

    Article  PubMed  CAS  Google Scholar 

  66. Winquist RA, Hansen ST, Clawson DK. Closed intramedullary nailing of femoral fractures. J Bone Joint Surg Am. 1984;66:529–539.

    PubMed  CAS  Google Scholar 

  67. Bucholz RW, Ross SE, Lawrence KL. Fatigue fracture of the interlocking nail in the treatment of fractures of the distal part of the femoral shaft. J Bone Joint Surg Am. 1987;69:1391–1399.

    PubMed  CAS  Google Scholar 

  68. Whittle AT, Russell TA, Taylor JC, Tagert BE. Interlocking interfragmentary nailing of distal intra-articular femoral fractures. Posterior Exhibit No. 4, Orthopedic Trauma Association, 1992 Annual Meeting, Minneapolis.

    Google Scholar 

  69. Henry SL, Seligson D, Trager S. Management of supracondylar fractures with the GSH intramedullary nail. In: American Academy of Orthopedic Surgeons, Annual Meeting; 1991: Paper 279.

    Google Scholar 

  70. Sanders RW, Swiontkowski M, Rosen H, Helfet D. Complex fractures and malunions of the distal femur: Results of treatment with double plates. J Bone Joint Surg Am. 1991;73:341–346.

    PubMed  CAS  Google Scholar 

  71. Matter P, Rittman W. The Open Fracture. Bern: Huber; 1978.

    Google Scholar 

  72. Helpenstell TS, Hansen ST. Review of 51 open distal femoral fractures treated with imediate open reduction and internal fixation. In: American Academy of Orthopedic Surgeons, Annual Meeting; 1991: Paper 274.

    Google Scholar 

  73. Seligson D, Kristiansen TK. Use of the Wagner apparatus in complicated fractures of the distal femur. J Trauma. 1978;18:795–799.

    Article  PubMed  CAS  Google Scholar 

  74. Stein H, Makin M. Use of the Wagner apparatus in fractures of the lower limb. Orthop Rev. 1980;9:96–99.

    Google Scholar 

Download references

Authors
  1. John M. Siliski
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Wang Ambulatory Care Center, Massachusetts General Hospital Harvard Medical School, Boston, MA, 02114, USA

    John M. Siliski M.D.

Rights and permissions

Reprints and permissions

Copyright information

© 1994 Springer-Verlag New York, Inc.

About this chapter

Cite this chapter

Siliski, J.M. (1994). Distal Femoral Fractures. In: Siliski, J.M. (eds) Traumatic Disorders of the Knee. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-4310-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-4310-6_9

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-8733-9

  • Online ISBN: 978-1-4612-4310-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation