Distal femur Partial articular fracture, frontal/coronal, anterior and lateral flake

Open reduction internal fixation (ORIF); screw fixation

ORIF - screw fixation

Indication summary: Displaced fractures

Skill: Highly experienced and skilled surgeon
Equipment: Full specialized surgical and imaging resources

The treatment of choice is open reduction and internal fixation.

Anterior and lateral flake fractures may be associated with patellar dislocation. These fractures may be small osteochondral fragments and may be technically unfixable. Small fracture fragments may need to be excised, or washed out of the knee joint arthroscopically.
Displaced fractures should be fixed with sunken screws, or bioresorbable pins, to achieve anatomical restoration of the articular surface, permitting early active mobilization of the joint surface. Larger fragments that are not in the femoral trochlea may be addressed arthroscopically. Reduction and cannulated screw/absorbable pin fixation is performed under arthroscopic control.

Indications

  • Displaced fractures
  • Additional knee ligament injury
  • Additional meniscial injury

Contraindications

  • Patient not medically fit for surgery
  • Local infection

Advantages

  • Open surgery offers possibility of treatment of associated knee derangements
  • Direct anatomical reduction
  • Early mobilization of the knee joint
  • Lower incidence of osteoarthritis

Disadvantages

  • Risk of nonunion and avascular necrosis
  • Risk of incorrect position of screws leading to impingement on patella
  • Risk of failure of bioresorbable pins

Legend

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

Appendix

Shortcuts

Contact | Disclaimer | AO Foundation

v1.0 2008-12-03