What is the treatment for a distal femur fracture?

Treatment for Distal Femur Fractures

Distal femur fractures require surgical fixation in most cases, with open reduction and internal fixation (ORIF) using locking plates being the preferred treatment method, especially for comminuted fractures with articular involvement.

Surgical Treatment Options

Open Reduction and Internal Fixation (ORIF)

• Locking plates are the mainstream fixation method for distal femur fractures 1

• Two primary approaches:

  • Minimally invasive plate osteosynthesis (MIPO) technique with locking plate alone
  • Open technique with combination of locking plate and interfragmentary screws

• Combination approach advantages:

  • Provides better stability
  • Results in faster time to full weight bearing (14.57 weeks vs 19.54 weeks with plate alone) 1
  • Lower revision surgery rates (combination: 2 patients vs plate alone: 9 patients) 1

Distal Femoral Replacement (DFR)

• Alternative option for elderly patients with osteoporotic bone
• Benefits for elderly patients:
  • Allows immediate weight-bearing
  • Quicker recovery time
  • Better pain management 2
  • Short surgical time with limited blood loss
• Particularly valuable for periprosthetic fractures around native or prosthetic knees 2

Treatment Algorithm Based on Fracture Type

Intra-articular Fractures

• Require anatomical reduction of articular fragments and rigid fixation 3
• Distal femur locking plates (DFLP) provide:
  • Angular stability
  • Multiple fixation options for both metaphyseal and articular fragments
  • Restoration of joint congruity, limb length, alignment and rotation 3
• Bone grafting may be required in cases with pre-operative bone loss (12% of cases) 3

Periprosthetic Fractures

• Both ORIF and DFR have similar surgical complication and reoperation profiles 4
• DFR has higher medical complication rates (23.1% vs 8.5% for ORIF) 4
• Failed ORIF can be salvaged with DFR 4

Post-Operative Management

Weight Bearing Protocols

• Early weight bearing (EWB) enhances bone healing and does not increase risk of fracture displacement or implant failure 5
• Restrictive weight-bearing may delay fracture healing and increase fixation failure risk 5

Rehabilitation

• Begin active finger motion exercises immediately following diagnosis to prevent stiffness 6
• Ice application during first 3-5 days for symptomatic relief 6
• After surgical fixation:
  • Early range of motion exercises as soon as stable fixation allows
  • Progressive weight bearing as tolerated
  • Strengthening exercises once healing is confirmed 6

Complications and Follow-up

• Common complications:

  • Infection (8% in early post-operative period)
  • Knee stiffness (12% of patients) 3
  • Nonunion and varus deformity (requiring revision surgery) 1

• Radiographic follow-up:

  • Should be performed at 3 weeks and at cessation of immobilization
  • Approximately 90% of fractures unite within 12 weeks 6

Special Considerations for Elderly Patients

• Evaluate for osteoporosis risk
• Consider calcium and vitamin D supplementation
• Assess fall risk factors 6
• Progressive weight bearing, range of motion exercises, strengthening exercises, and balance training to prevent future falls 6

Pitfalls to Avoid

• Delaying weight bearing unnecessarily can delay healing and increase fixation failure risk 5
• Inadequate fixation of articular fragments can lead to poor functional outcomes 3
• Failure to address osteoporosis in elderly patients can lead to fixation failure and recurrent fractures 6