Executive Editor: Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Distal femur

back to skeleton

Glossary

Extraarticular fracture, avulsion

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
ORIF - lag screws Displaced fracture Some specialized surgical experience Simple surgical and imaging resources

Extraarticular fracture, simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
Temporary skeletal traction Displaced open fracture, medically unfit patient Some specialized surgical experience Simple surgical and imaging resources
MIO - dynamic condylar screw (DCS) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - condylar locking compression plate (LCP) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - retrograde nailing Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck fracture. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - dynamic condylar screw (DCS) Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - condylar locking compression plate (LCP) Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - blade plate Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular fracture, wedge

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Stabe undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
Temporary skeletal traction Displaced open fracture, medically unfit patient Some specialized surgical experience Simple surgical and imaging resources
MIO - dynamic condylar screw (DCS) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - condylar locking compression plate (LCP) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - less invasive stabilization system (LISS) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - retrograde nailing Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck fracture. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - dynamic condylar screw (DCS) Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - condylar locking compression plate (LCP) Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - blade plate Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Extraarticular fracture, multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Medically unfit patient, undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
Temporary skeletal traction Displaced open fracture, medically unfit patient Some specialized surgical experience Simple surgical and imaging resources
MIO - dynamic condylar screw (DCS) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - condylar locking compression plate (LCP) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - less invasive stabilization system (LISS) Displaced reducible fracture, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
MIO - retrograde nailing Closed fractures, Gustilo types I & II open fractures, stable polytrauma. “Floating knee” injury, bilateral lower extremity fractures. Pregnancy. Obesity. Ipsilateral femoral neck fracture. Concomitant ipsilateral acetabular / pelvic ring fractures. Fracture below hip prosthesis. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - dynamic condylar screw (DCS) Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - condylar locking compression plate (LCP) Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - blade plate Indirect reduction not possible, image intensification not available, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular fracture, lateral condyle, sagittal simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
MIO - lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
MIO - cannulated lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - lag screws Large fragment, good bone quality, low demand patient Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular fracture, lateral condyle, sagittal fragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
ORIF - lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular fracture, medial condyle, sagittal simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
MIO - lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
MIO - cannulated lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - lag screws Large fragment, good bone quality, low demand patient Some specialized surgical experience Full specialized surgical and imaging resources
ORIF - lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular fracture, medial condyle, sagittal fragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
ORIF - lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws Large fragment, good bone quality, low demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - cannulated lag screws with buttress plate Large fragment, high demand patient Highly experienced and skilled surgeon Full specialized surgical and imaging resources

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

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture, low demand patient Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
ORIF - screw fixation Displaced fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Partial articular fracture, frontal/coronal, posterior condyle(s)

Please select a treatment option:
Treatment Indication summary Skill Equipment
Long leg cast then hinged knee brace Undisplaced fracture, low demand patient Basic surgical experience, no specialized skills Basic equipment only
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
ORIF - anterior screws for large fragments Displaced large fragments Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - posterior screws for small fragments Displaced small fragments Highly experienced and skilled surgeon Simple surgical and imaging resources

Complete articular fracture, simple articular, simple methaphyseal

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
Temporary skeletal traction Displaced fracture, medically unfit patient Some specialized surgical experience Simple surgical and imaging resources
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
ORIF - dynamic condylar screw (DCS) Metaphyseal fracture more proximal Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - condylar locking compression plate (LCP) Displaced articular fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - blade plate Metaphyseal fracture more proximal Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - retrograde nailing Articular fracture undisplaced, metaphyseal fracture proximal Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete articular fracture, simple articular, multifragmentary methapyseal

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
Temporary skeletal traction Displaced fracture, medically unfit patient Some specialized surgical experience Simple surgical and imaging resources
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
ORIF - dynamic condylar screw (DCS) Metaphyseal fracture more proximal Highly experienced and skilled surgeon Simple surgical and imaging resources
ORIF - condylar locking compression plate (LCP) More distal metaphyseal fractures, articular fracture displaced, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - less invasive stabilization system (LISS) More distal metaphyseal fractures, articular fracture displaced, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - blade plate Metaphyseal fractures more proximal Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - retrograde nailing Articular fracture undisplaced, metaphyseal fractures proximal Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Complete articular fracture, multifragmentary articular

Please select a treatment option:
Treatment Indication summary Skill Equipment
Temporary external fixator Damage control Some specialized surgical experience Simple surgical and imaging resources
Temporary skeletal traction Displaced fracture, medically unfit patient Some specialized surgical experience Simple surgical and imaging resources
Temporary long leg splint Displaced fracture, medically unfit patient Basic surgical experience, no specialized skills Basic equipment only
ORIF - condylar locking compression plate (LCP) More distal metaphyseal fractures, articular fracture displaced, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources
ORIF - less invasive stabilization system (LISS) More distal metaphyseal fractures, articular fracture displaced, Surgeon's preference Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations

Principles of management of open fractures
Infection
Compartment syndrome
*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