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Presenter discusses management of complex distal femur fractures
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WAIKOLOA, Hawaii — Surgeons should consider fracture location, bone quality and implant stability when they treat complex distal femoral fractures, according to a presenter at Orthopedics Today Hawaii.
“A lot of [fractures] can be fixed but occasionally if the implant stability is compromised, you are dealing with a large revision,” Steven J. MacDonald, MD, said during his presentation.
MacDonald said the incidence of distal femur fractures is understood; however, the incidence has increased. Most distal femur fractures are undisplaced and have a stable implant, so open reduction and internal fixation is the treatment of choice with either a plate or nail, he said.
“As the fracture becomes more proximal (ie, more diaphyseal), then that becomes amenable to using a nail,” MacDonald said. “As the fracture pattern gets closer and closer to the implant itself, nails get harder to do and that’s where you are going to be using a plate for those cases.”
He said what really drives treatment with a nail is fracture location. He said surgeons need to understand the implant they use because that determines how easy the surgery will be.
He said when plates are used, it can be a minimally invasive procedure. The biology needs to be respected when plates are used, MacDonald said, and a failed or loose implant is an indication for revision surgery.
“If these fractures are left to heal, they end up being in positions that are not that functional for the patient,” MacDonald said.
He added, “The real thing to be aware of is this femoral component rotation because you lost your landmarks, [so] you need to make sure you don’t internally rotate that construct. So, you base it off of the tibial component and make sure you externally rotate it.” - by Monica Jaramillo
Reference:
MacDonald SJ. Management of Complex Distal Femur Fractures. Presented at: Orthopedics Today Hawaii; Jan. 13-17, 2019; Waikoloa, Hawaii.
Disclosure: MacDonald reports he received institutional/educational support from Smith & Nephew, DePuy and Stryker; is a consultant and receives royalties from DePuy; and holds stock in Hip Innovation Technologies, JointVue, PSI and Curvafix.