The normal anatomic axis of the distal femur is 6 to 7 degrees of valgus in a male and 8 to 9 degrees in a female. The purpose of this study was to analyze the complications and clinical outcomes of lp treatment for distal femoral fractures. Ap and lateral radiographs of the thigh showing displaced oblique femoral mid shaft fracture. The fracture can range from a small crack to a full break that allows part of the bone to separate. Midshaft femur fracture all subtrochanteric pediatric hip pain. As the most commonly fractured long bone, it is not surprising that the femur was the first bone in which internal fixation was attempted.
Pdf diagnostic and management aspects of obstetric. Supracondylar soopruhkondehlahr femoral fracture also called distal distuhl femur fracture is when the thigh bone breaks at the knee. This type of cornoal fractures of he distal femur are further classified into. Management of fractures of distal femur journal of.
The role of fractureassociated soft tissue injury in the induction of systemic inflammation and remote organ dysfunction after bilateral femur fracture. Pdf current concepts in fractures of the distal femur. Patients suffering a distal femoral fracture are at a high risk of morbidity and mortality. Fractures of the femoral shaft often result from high energy forces such as motor vehicle collisions. Supracondylar fracture types, treatment, classification. May 04, 2016 the b3 type fracture popularly known as hoffas fracture has immense clinical signifcance in the outcome following treatment and has been further subdivided into three types 3,8,10. Fracture shaft of femur a femoral shaft fracture is a fracture of the femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle 6. Management of fractures of distal femur journal of medical. Epidemiology common injury due to major violent trauma 1 femur fracture 10,000 people more common in people 65 yr motor vehicle.
Operative treatment of acute distal femur fractures. Supracondylar fractures are most common in patients who suffer from osteoporosis or have had total knee replacement surgery. The ulnar nerve with its posterior location is uncommonly involved with a typical extensiontype supracondylar fracture. There are different kinds of breaks, from simple to serious. Suffered since 3 hours before admitted to the hospital due to a traffic accident. Predicting survival after treatment for fracture of the. It is a fracture of femoral diaphysis occurring between 5cm distal to lesser trochanter and 5cm proximal to adductor tubercle. The femur is the largest and strongest bone in the body, so it takes tremendous force to cause a fracture. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter see hip fractures. A comparison of mortality following distal femoral. Distal femur fractures and its treatment with distal femur. Anteroposterior radiograph of the proximal femur a and lateral b and anteroposterior c radiographs of the distal femur showing femur fracture without evidence of healing in a 30yearold man.
These fractures were surgically treated by ao principles and fixation, and the surgery performed mainly by the two authors. Understanding characteristics of distal femoral fractures as well as the principles and challenges of management is important in optimizing outcomes. Fracture of shaft of femur 1 fracture of shaft of femur 2. Patient ages ranged from 1month to 15 years, with a mean of 3. Supracondylar femoral fractures occur commonly among two populations, young patients involved in highenergy accidents including motor vehicle and motorcycle accidents and sports trauma and older patients, often osteoporotic, sustaining low. Most nerve injuries are associated with type iii displaced supracondylar fractures. The lateral cortex of the femur has a 10 degree slope, and the medial cortex slopes 25 degrees. The clavicle fracture was the most common obstetric bone lesion in our series with a percentage of 77% followed by fracture of the femur and humerus with 12% and 11% respectively. Comparison of supraintercondylar and supracondylar femur. Apr 20, 2016 fracture shaft of femur a femoral shaft fracture is a fracture of the femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle 6. Morbidity and mortality of bilateral femur fractures.
A supracondylar fracture has three classifications, determined by the degree of separation of the fracture fragments. This study aims to compare their mortality rates and assess whether surgical intervention improves either outcome or mortality following distal femoral fractures. Unicondylar fractures of the distal femur are rare lesions, that often occur in combination with other posttraumatic injuries and may therefore fail to be recognised initially. Supracondylar sooprukondilar femoral fracture also called a distal distuhl fracture is when the thigh bone, or femur, is broken at the knee. Ease of insertion, the ability to obtain good fixation even in osteoporotic bone, and the capability of revising nonunions with a. Treatment is usually closed reduction and percutanous pinning crpp, with the urgency depending on whether the hand remains perfused or not. The femur is the largest and strongest bone in the body. Gartlands classification of supracondylar fracture of humerus.
Supracondylar fractures of the femur 33a, b, and c. Supracondylar femur fractures clinical presentation. The thin soft tissue coverage on the anterior aspect of the distal end of the femur is a frequent. Treatment of supracondylarintracondylar fractures of the fe. Complications and injuries associated with midshaft femur fractures in the adult can be lifethreatening and may include. Open fracture occurs in 5% to 10% of supracondylar fractures. Fracture of distal of femur, neer scale, asif introduction the fractures of distal femur are defined as those fractures involving the last 15 cm of the femur measured from the knee joint line. Unicondylar fractures of the distal femur sciencedirect. The distal femur forms the top part of the knee joint.
Another genesis of femur fractures is carcinogenic. Currently this cohort is not afforded the same resources as those with hip fractures. The radial nerve lies posterolateral to the usual location of supracondylar fractures and, thus, is less commonly involved see fig. The lower part of the knee joint is the shin bone, or tibia tihbeeuh. Standard treatments include open reduction and internal fixation. They are caused by a direct impact on the flexed knee during weight bearing. A thorough neurovascular examination of the affected extremity before and after reduction is essential. A femoral fracture is a bone fracture that involves the femur. The incidence of supracondylar fracture after total knee arthroplasty is approximately 1%.
Oct, 2017 supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. C2 complete simple articular fracture with multifragmented metaphysis. The most common fracture type of the femoral shaft is a noncomminuted simple ao type a, most of which, in traumatic fractures, are purely transverse and located in the middle third of the femur. Usually occur in young men after high energy trauma and elderly women even after a low energy fall. Supracondylar femur fractures require anatomically stable internal fixation for best results, which usually necessitates surgical treatment. Fifty consecutive patients were introduction abstract in this prospective study, 50 patients with distal femur fracture were treated using distal femur locking plate. Ppt fracture of shaft of femur powerpoint presentation. The third type is distal femoral fractures, also called supracondylar femur fracture, an injury to the thigh bone just above the knee joint. The overall results were seen to be excellent to good in 71%, and excellent to good to fair in 83% of the cases. Under normal circumstances, our bones are continually breaking down and rebuilding themselves, allowing new bone to replace old, thereby constantly maintaining a. This condition is a break in the femur at the knee joint.
Therefore, the purpose of this study was to analyze the complications and clinical outcomes of locked plating for supracondylar femur fractures utilizing cains 9, kristensens 11, and. In a recent study by louahem et al, 46 the most commonly injured nerve was the anterior interosseous branch of the median nerve. Distal femur lecture orthopaedic trauma association ota. Typically, because of the strength of the bone, it takes either tremendous force or a defect of the bone to cause a femur fracture. This injury can involve the cartilage on the base of the femur in the knee joint, and may increase the risk of developing knee arthritis later in life. The femur is the longest, strongest, and heaviest tubular bone in the human body and one of the principal load bearing bones in the lower extremity. Despite technique suggestions from anecdotal and some early reports, knowledge about risk factors for failure, nonunion nu, and revision is limited. Clinical outcomes of locked plating of distal femoral. Rightleft % 5149 compound fracture % 17 multiple fractures % 44 knee osteoarthritis % 5 type of trauma % from standing height 42 fall from. Distal femoral fractures reportedly account for less than 1% of all fractures and comprise between 4%6% of all femoral fractures.
Supracondylar femoral fracture central coast orthopedic. Treatment of supraintercondylar aoota 33c and supracondylar aoota 33a femur fractures is generally challenging. Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery elliott, j. Treatment of supracondylarintracondylar fractures of the. Schatzker j, horne g, waddell j 1974 the toronto experience with the supracondylar fracture of the femur 19661972. The knees are the largest weight weightbearing joint in your body. Old and fresh cases and, simple or compound fractures were taken up. This study focus on the comparison between clinical and functional outcomes of fractures treated with condylar buttress plates cbps.
Proximal fracture of the femur is the main cause of morbidity, institutionalization and mortality in the elderly. Surgical therapy is focused on immediate fracture stabilisation offering a durable and solid fixation. The thin soft tissue coverage on the anterior aspect of the distal end of the femur is a frequent problem. Parallel increasing numbers of fatigue femur fractures are observed fol. Nerve injuries occur in about 40% of type iii gartlands classification supracondylar fractures earlier literature stated that radial nerve was the most commonly injured nerve in supracondylar fractures but recent studies indicate that the anterior interosseous branch of median nerve is mostly affected nerve involvement differ with the type of fracture anterior interosseous nerve is. Whether they are transverse, oblique, or comminuted, supracondylar or intercondylar in a t, y or v fashion their management still evokes much controversy because of the consistently poor results obtained. This is likely due to its anatomic arrangement of the exclusively motor posterior fascicles which are exposed to the zone of injury, and its tight tethering to. The fracture line starts in the lateral or medial intercondylartrochlear groove.
It includes the metaphyseal fractures supra condylar fractures and the fractures of the joint surface intraarticular fractures. Supracondylar definition of supracondylar by the free. The most common mechanism is an indirect trauma on a bent knee, and more rarely direct trauma by crushing. The incidence of pediatric femur fractures is 19 in. Nail dynamization for delayed union and nonunion in femur. Mortality is estimated at 24% up to 12 months after the hip. Pdf supracondylar fracture of the femur in children. Locked plating lp of distal femoral fractures has become very popular. Complications of supracondylar fractures of the elbow. Nov 27, 20 locked plating lp of distal femoral fractures has become very popular. Pediatric supracondylar fractures are one of the most common traumatic fractures see in children and most commonly occur in children 57 years of age, usually from a fall on an outstretched hand. Femur fractures the femur, or thigh bone, is one of the largest and strongest bones in the body. Spiral fractures that are related to low energy trauma situate in the middle third of.
Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery. These fractures usually occur in elderly patients with multiple comorbidities and osteoporotic bone. Distal femur supracondylar fracture everything you need to know dr. Management of fracture of distal end of femur by of. Supracondylar fracture pediatric pediatrics orthobullets. Using mullers fracture classification, the less comminuted fractures were found to have better results than those with more comminution.
Anteroposterior ap and lateral xrays of the distal humerus not elbow should be ordered if a supracondylar fracture of the humerus is suspected. They are typically sustained in highimpact trauma, such as car crashes, due to the large amount of force needed to break the bone. Jun 08, 2018 distal femur supracondylar fracture everything you need to know dr. B3 partial articular fracture, coronal hoffa fracture. The femur is composed of three separate regions figure 612 74. The association between bisphosphonates and femur fracture is discussed separately see risks of bisphosphonate therapy in patients with osteoporosis, section on atypical femur fractures and the use of bisphosphonates in postmenopausal women with osteoporosis, section on overview of approach. Type 1 this is a minimally or undisplaced fracture, which means there is a hairline fracture. Nerve injury in supracondylar fracture of humerus pg blazer. Osteolytic or osteoblastic metastasis can lead to pain and immobilisation due to a pathologic femur fracture. Analysis of femoral fracture post motor vehicle accidents finnegan 1978. Lowprofile, anatomically shaped plates designed for left or right femur. Supracondylar femur fractures orthopaedicsone articles.
The most common cause of a fracture is direct trauma to the leg from an automobile accident or a fall. Nonphyseal supracondylar fractures of the femur are considered to be uncommon in children and have received little attention in the literature. However, optimal implants are now being welldefined. Immobilisation in an aboveelbow backslab in 90 degrees elbow flexion with sling for 3 weeks. The backslab and sling should be worn under clothing e. Jul 10, 2015 the role of fractureassociated soft tissue injury in the induction of systemic inflammation and remote organ dysfunction after bilateral femur fracture. Neurovascular injuries are mostly observed in the type 3 distal femur complex trauma.
686 1513 986 959 325 1432 199 808 518 1516 624 1033 333 166 791 567 313 220 98 856 863 440 1426 837 1236 943 503 434 809 846 1444 492 34