Distal femur fractures are among the most challenging injuries around the knee, with a classic bimodal distribution in young men and elderly women. This masterclass walks you through AO/OTA classification, the occult Hoffa fragment, implant selection between retrograde nail and locking plateand when to consider distal femoral replacement. ⏱ Chapters 0:00 Intro 0:21 Essentials 0:49 Classification 1:12 Rorabeck 1:33 Gras 1:55 Hoffa 2:18 Imaging 2:42 Algorithm 3:16 Nailvsplate 3:43 Dfr 4:10 Numbers 4:43 Clinical Reasoning 1 5:09 Clinical Reasoning 2 A comprehensive, evidence-based walkthrough of distal femur fracture management covering epidemiology, vascular assessment, the trapezoidal distal femoral anatomy, AO/OTA 33-A/B/C classification, Rorabeck periprosthetic types, deforming forces (the GRAS mnemonic), Hoffa fracture detection and fixation, surgical sequencing (reconstruct the articular block first, then attach to the shaft), retrograde nail versus lateral locking plate decision-making, dual plating for medial comminutionand distal femoral replacement in the elderly. Designed to build confident, structured decision-making for any orthopaedic clinician managing these injuries. 🦴 IN THIS VIDEO YOU'LL LEARN • Apply the AO/OTA 33-A, 33-B and 33-C classification to distal femur fractures and select the appropriate implant for each pattern • Recognise the bimodal epidemiology and perform mandatory vascular assessment of the tethered popliteal artery • Identify the often-occult Hoffa (coronal plane) fragment and understand why CT is mandatory for all intra-articular fractures • Use the GRAS mnemonic to predict deforming forces — gastrocnemius recurvatum, adductor varus, quadriceps and hamstring shortening • Compare retrograde intramedullary nailing with lateral locking plate fixation, including when dual medial plating is required • Classify periprosthetic supracondylar fractures using the Rorabeck system and decide between fixation and revision arthroplasty • Execute the operative sequence of anatomic articular reduction (step-off under 2 mm) followed by restoration of length, rotation and axis • Restore the lateral distal femoral angle to 81 degrees and the 6-degree anatomic valgus • Identify indications for distal femoral replacement in elderly independent ambulators with severe comminution • Recognise associated injuries including the floating knee, vascular compromise and compartment syndrome ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ CT is mandatory for every intra-articular distal femur fracture — 38% hide a coronal Hoffa component missed on plain films ✔️ Reconstruct the articular block first with step-off under 2 mm, then fix it to the shaft restoring length, rotation and axis ✔️ Retrograde nail is the workhorse for extra-articular (33-A) fractures and allows immediate weight bearing ✔️ Lateral locking plate is the workhorse for complete articular (33-C) patterns; add a medial plate or strut when the medial column is comminuted ✔️ Hoffa fractures are fixed with anterior-to-posterior lag screws placed perpendicular to the fracture line ✔️ In the elderly, restricted weight bearing carries unacceptably high mortality — distal femoral replacement enables immediate mobilisation ✔️ A loose TKA component with any distal femur fracture mandates revision arthroplasty, not internal fixation 👩⚕️ WHO THIS IS FOR This masterclass is built for orthopaedic trainees, residents and surgeons managing lower-limb trauma, as well as medical students, physiotherapists and informed patients who want a structured understanding of how distal femur fractures are classified and treated. 📚 RELATED TOPICS: Tibial plateau fractures · Patella fractures · Periprosthetic fractures around total knee replacement · Floating knee injuries · Supracondylar femur fracture non-union · Distal femoral replacement and megaprosthesis reconstruction · Knee stiffness and post-traumatic osteoarthritis · Popliteal artery injury in knee trauma · Locking plate principles and working length · Retrograde intramedullary nailing of the femur 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #orthopedics #trauma #distalfemur #distalfemurfracture #supracondylarfemur #hoffafracture #fracturemanagement #kneefracture #retrogradenail #lockingplate #periprostheticfracture #totalkneereplacement #orthopaedicsurgery #fractureclassification