Executive Editor: Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Distal Femur Extraarticular fracture, avulsion

back to skeleton

Glossary

General considerations

Avulsion of the femoral attachment of one of the collateral ligaments: On the medial side, it is not to be confused with Pelegrini-Steida syndrome. If displaced, surgical reattachment is to be considered.

Long leg cast then hinged knee brace
Indication summary Skill Equipment
Undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only

Some fractures can be treated nonoperatively. Nonoperative treatment can consist of a long leg cast, followed by a hinged knee brace.

Indications

  • Undisplaced fracture, with no additional knee ligament injury and no meniscal injury
  • Medically unfit for surgery
  • Polytrauma, in extremis

Contraindications

  • Displacement of fracture
  • Additional derangement of the knee

Advantage

  • No surgery

Disadvantages

  • Weakening of extensor mechanism
  • Risk of knee stiffness secondary to immobilization
  • Risk of nonunion
Temporary long leg splint
Indication summary Skill Equipment
Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only

In occasional cases, a period of nonoperative treatment may be necessary before the patient’s general condition, or the local status of the soft-tissues, will permit safe surgery. In these circumstances, a period of temporary splintage can be used.

Indication

  • Temporarily unfit for surgery

Contraindication

  • Severe obesity

Advantages

  • Inexpensive
  • Quick, noninvasive procedure

Disadvantages

  • Skin break down
  • Loosening of the splint
  • Knee stiffness
Temporary external fixator
Indication summary Skill Equipment
Damage control Some specialized surgical experience Simple surgical and imaging resources

In occasional cases, a period of nonoperative treatment may be necessary before the patient’s general condition, or the local status of the soft-tissues, will permit safe surgery. In these patients, temporary external fixation may be useful.

Further indication

  • Associated vascular injury

Contraindication

  • Existing prosthesis/implant conflicting with pin tracks

Advantages

  • Minimally invasive
  • Rapid procedure

Disadvantages

  • Potential knee stiffness
  • Fixator pins may compromise sterility, future incisions, or definitive fixation
ORIF - lag screws
Indication summary Skill Equipment
Displaced fracture Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Displaced fractures
  • Young active patient
  • Additional derangement of the knee

Contraindication

  • Patient unfit for surgery

Advantages

  • Fracture stabilization allows early patient mobilization
  • Allows for examination under anesthesia of the knee

Disadvantages

  • Surgical scarring
  • Risk of infection
*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

v1.0 2008-12-03