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.
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