Equipment

Necessary equipment depends on technique and includes the following:

95º blade plate
95º condylar screw
Distal femur buttress plate
External fixator

Anesthesia

General anesthesia is used for complete muscle relaxation to facilitate anatomic fracture reduction.

Positioning

The patient is positioned supine on a flat-top Jackson table to allow C-arm imaging. An ipsilateral bump is placed underneath the hip to allow some internal rotation to gain lateral exposure to the distal femur.

Monitoring & Follow-up

Postoperative immobilization depends on the rigidity of your construct and fracture stability. If the fracture is rigidly fixed, a hinged knee brace may be used postoperatively to allow knee range of motion (ROM) and no weightbearing on the extremity until bone healing is evident at approximately 12 weeks.^[7]

If the fixation construct is not rigid, the patient may be immobilized in a splint for approximately 4-6 weeks and then transitioned to a hinged knee brace.

Radiographs at regular intervals are necessary to assess fracture healing. Patients may be seen initially at 2 weeks postoperatively and then at monthly intervals until the fracture is healed.

Technique

Collinge CA, Wiss DA. Distal femur fractures. Tornetta P III, Ricci WM, Ostrum RF, McQueen MM, McKee MD, Court-Brown CM, eds. Rockwood and Green’s Fractures in Adults. 9th ed. Philadelphia: Wolters Kluwer; 2020. Vol 2: Chap 57.
Albert MJ. Supracondylar Fractures of the Femur. J Am Acad Orthop Surg. 1997 May. 5 (3):163-171. [QxMD MEDLINE Link].
Haidukewych GJ, Berry DJ, Jacofsky DJ, Torchia ME. Treatment of supracondylar femur nonunions with open reduction and internal fixation. Am J Orthop (Belle Mead NJ). 2003 Nov. 32 (11):564-7. [QxMD MEDLINE Link].
Ebraheim NA, Buchanan GS, Liu X, Cooper ME, Peters N, Hessey JA, et al. Treatment of Distal Femur Nonunion Following Initial Fixation with a Lateral Locking Plate. Orthop Surg. 2016 Aug. 8 (3):323-30. [QxMD MEDLINE Link].
Darrith B, Bohl DD, Karadsheh MS, Sporer SM, Berger RA, Levine BR. Periprosthetic Fractures of the Distal Femur: Is Open Reduction and Internal Fixation or Distal Femoral Replacement Superior?. J Arthroplasty. 2020 May. 35 (5):1402-1406. [QxMD MEDLINE Link].
Ruder JA, Hart GP, Kneisl JS, Springer BD, Karunakar MA. Predictors of Functional Recovery Following Periprosthetic Distal Femur Fractures. J Arthroplasty. 2017 May. 32 (5):1571-1575. [QxMD MEDLINE Link].
Thomson AB, Driver R, Kregor PJ, Obremskey WT. Long-term functional outcomes after intra-articular distal femur fractures: ORIF versus retrograde intramedullary nailing. Orthopedics. 2008 Aug. 31 (8):748-50. [QxMD MEDLINE Link].
Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014 Feb. 28 (2):83-9. [QxMD MEDLINE Link].
Barei DP, Beingessner DM. Open distal femur fractures treated with lateral locked implants: union, secondary bone grafting, and predictive parameters. Orthopedics. 2012 Jun. 35 (6):e843-6. [QxMD MEDLINE Link].
Ricci WM, Streubel PN, Morshed S, Collinge CA, Nork SE, Gardner MJ. Risk factors for failure of locked plate fixation of distal femur fractures: an analysis of 335 cases. J Orthop Trauma. 2014 Feb. 28 (2):83-9. [QxMD MEDLINE Link].
Chen AF, Choi LE, Colman MW, Goodman MA, Crossett LS, Tarkin IS, et al. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures. J Arthroplasty. 2013 Oct. 28 (9):1580-4. [QxMD MEDLINE Link].
Dodd AC, Salib CG, Lakomkin N, Obremskey WT, Sethi MK. Increased risk of adverse events in management of femur and tibial shaft fractures with plating: An analysis of NSQIP data. J Clin Orthop Trauma. 2016 Apr-Jun. 7 (2):80-5. [QxMD MEDLINE Link].
Lu K, Zhang J, Cheng J, Liu H, Yang C, Yin L, et al. Incidence and risk factors for surgical site infection after open reduction and internal fixation of intra-articular fractures of distal femur: A multicentre study. Int Wound J. 2019 Apr. 16 (2):473-478. [QxMD MEDLINE Link].
Lill M, Attal R, Rudisch A, Wick MC, Blauth M, Lutz M. Does MIPO of fractures of the distal femur result in more rotational malalignment than ORIF? A retrospective study. Eur J Trauma Emerg Surg. 2016 Dec. 42 (6):733-740. [QxMD MEDLINE Link].