Presentation
Case presentation A 12-year-old boy with paraplegia due to neuromyelitis optica presented with progressive right knee pain and swelling. There was no history of trauma to the knee. [ncbi.nlm.nih.gov]
(OBQ12.33) A 44-year-old male is involved in a motorcycle collision and presents with the radiographs shown in Figure A. [orthobullets.com]
Subtrochanteric and Distal Femur Fractures in a Patient with Femoral Shaft Fracture Malunion and Knee Disarticulation: A Rare and Challenging Case Report Abstract This study aims to describe a rare and challenging case of a patient who presented ipsilateral [ajol.info]
Skin
- Short Nails
[…] placement technique insertion requires ≥70º knee flexion starting point at superior margin of Blumensaat line (lateral) and center of intercondylar notch (AP) blocking screws facilitate reduction and strengthen construct short nail rarely indicated, [orthobullets.com]
A mechanical study of gap motion in cadaveric femurs using short and long supracondylar nails.. J Orthop Trauma. 2004 Jul;18(6):354-60. 20. Moed BR, Watson JT. [oapublishinglondon.com]
Workup
Assessment Initial Investigations should include: General workup including FBC and cross match, renal function, glucose, ECG and, if indicated, CXR, intravenous access with intravenous infusion if indicated. [patient.info]
Patients were taken up for surgery after routine preoperative workup. All the patients were operated within 10 days of the initial trauma. [ijoonline.com]
Treatment
The two most successful treatment options for periprosthetic distal femur fractures were locking plate (87%) and intramedullary nail/rod (84%). [ncbi.nlm.nih.gov]
The goal of this study is to directly compare the two treatments to see if one treatment results in better patient outcomes than the other. [clinicaltrials.gov]
(Nork SE, JBJS Am 2005;87:564-569) Distal Femur Fracture Classification/Treatment AO Classification Type A=extraarticular -Treatment = retrograde IM nail or ORIF usually via minimal lateral approach Type B=unicondylar fractures -Treatment = percutaneous [eorif.com]
Patients with severe soft tissue damage underwent staged treatment, initiated by external fixation and followed by use of an internal fixator. All open fractures underwent staged treatment, with temporary transarticular external fixator. [scielo.br]
Prognosis
Severely comminuted fractures, poor bone quality, poor reduction, and poor fixation worsen the prognosis. Type C3 fractures are expected to develop significant secondary degenerative changes. Open fractures have a worse prognosis. [boneandspine.com]
Moreover, there was no information on the prognosis of these injuries[3]. Hence, this system did not gain much popularity and is seldom used anywhere now among trauma surgeons worldwide. [traumainternational.co.in]
The prognosis of knee function is directly related to surgical technique accuracy. REFERENCES 1. Arneson TJ, Melton LJ 3rd, Lewallen DG, O'Fallon WM. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. [scielo.br]
Andhra Pradesh, India *Corresponding author Email: [email protected] Abstract Introduction In recent years, the treatment of distal femoral fractures has evolved although these fractures remain complex to treat and carry an inconsistent prognosis [oapublishinglondon.com]
Etiology
[…] with malunion Q- subsequent encounter for open fracture type I or II with malunion R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S- sequela Distal Femur Fracture ICD-9 821.23(closed) 821.33(open) Distal Femur Fracture Etiology [eorif.com]
[…] accidents are more common in the younger population as compared with low-energy mechanisms such as fall from stand in the elderly and osteoporotic patients.2 Distal femoral fractures are often complex, intraarticular, and comminuted, irrespective of etiology [journals.lww.com]
/Sex/Age, y Etiology OTA AO Fracture Type Open/Closed Deformity During IM Nailing Technique Blocking Screw FU, mo Fracture Union Time, wk 1/M/28 Traffic accident, polytrauma 32 B2 Closed Varus at coronal plane Antegrade 1 to distal from medial side 24 [healio.com]
Epidemiology
Coverage begins with a section on General Principles, including biomechanics, classification, epidemiology, principles of internal and external fixation, bone grafting, outcome studies, and imaging. [books.google.com]
[ 1 ] Kannus, P., Parkkari, J., Sievanen, H., et al. (1996) Epidemiology of Hip Fractures. [scirp.org]
Basic epidemiology of fractures of the upper and lower limb among Americans over 65 years of age. Epidemiology. 1996 Nov. 7(6):612-8. [Medline]. Harrington KD. Orthopaedic management of extremity and pelvic lesions. [emedicine.medscape.com]
The epidemiology of fractures of the distal femur. Injury 2000;31(3):C62–3. Streubel PN, Ricci WM, Wong A, Gardner MJ. Mortality after distal femur fractures in elderly patients. Clin Orthop Relat Res 2011;469(4):1188–96. [jamc.ayubmed.edu.pk]
EPIDEMIOLOGY Kolmert and Wulff 2 analyzed the epidemiology of distal femoral fractures in Malmö, Sweden, in 1969–1976. [musculoskeletalkey.com]
Pathophysiology
Pathophysiology Diaphyseal fractures result from significant force transmitted from a direct blow or from indirect force transmitted at the knee. [3] Pathologic fractures may occur with relatively little force. [4] These may be the result of bone weakness [emedicine.medscape.com]
[…] include open reduction with internal fixation, intramedullary nail fixation, and distal femur replacement Epidemiology incidence 3-6% of femur fractures <1% of all fractures demographics bimodal distribution young healthy males elderly osteopenic females Pathophysiology [orthobullets.com]
Prevention
We thought we have used it as a reduction screw but it acted as a lag screw, preventing motion at the fracture site. Given this analysis, we have only taken the lag screw out to make the construct less stable. [ncbi.nlm.nih.gov]
Newer techniques and implants may help prevent this risk, but cannot eliminate it entirely. Your commitment to your recovery. [orthoinfo.aaos.org]
[…] distal fractures, the knee must be flexed and a distal femoral traction pin must be inserted; - flexed knee position releaxes the posterior knee capsule and the gastrocnemius muscle, thereby avoiding a hyperextension deformity at the fracture, which can prevent [wheelessonline.com]
It only considered definitive treatment for patients with significant comorbidities that contraindicate surgical management. [13] External fixators [ edit ] External fixators can be used to prevent further damage to the leg until the patient is stable [en.wikipedia.org]