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trauma

Distal Femur Fracture

advanced
6 min
30 marks
6 questions
Clinical Scenario
A 70-year-old woman with osteoporosis presents after a fall at home. She has obvious thigh deformity with shortening. X-rays show a comminuted supracondylar femur fracture with intra-articular extension. There is no vascular compromise. She has a well-functioning TKA in the other knee.
AP and lateral radiographs demonstrating comminuted supracondylar femur fracture with intra-articular extension (AO 33-C2). There is metaphyseal comminution, varus angulation, and shortening. The articular surface shows a simple sagittal split pattern requiring anatomic reduction.
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AP and lateral radiographs demonstrating comminuted supracondylar femur fracture with intra-articular extension (AO 33-C2). There is metaphyseal comminution, varus angulation, and shortening. The articular surface shows a simple sagittal split pattern requiring anatomic reduction.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (5 marks)

How do you classify this fracture? What key features guide your management?

Question 2 (5 marks)

What are the surgical options and which approach would you use?

Question 3 (5 marks)

Describe your surgical technique for ORIF with lateral locked plate.

Question 4 (5 marks)

How do you manage fixation in osteoporotic bone?

Question 5 (5 marks)

This patient had a TKA. How would a periprosthetic fracture change your classification and management?

Question 6 (5 marks)

What are the expected outcomes and complications?

Exam Day Cheat Sheet

Must Mention

  • •AO: 33-A (extra-articular), 33-B (partial), 33-C (complete articular)
  • •Articular reduction = anatomic; Metaphyseal comminution = bridge
  • •All locking screws in osteoporosis
  • •Plate length: 2:1 working length ratio
  • •Rorabeck: I = brace, II = ORIF, III = revision
  • •Unicortical distal screws near prosthesis

Common Pitfalls

  • •Reducing comminuted metaphysis (strips blood supply, no benefit)
  • •Short plate in osteoporosis (fixation failure)
  • •Missing rotation (check lesser trochanter profile)
  • •Bicortical screws through prosthesis
  • •Not checking prosthesis stability before fixation decision
  • •Ignoring bone quality in elderly