What is the operative procedure for open reduction internal fixation of a right distal femur fracture?

Operative Note: Right Distal 1/3 Shaft of Femur Fracture ORIF with Plating

The open reduction and internal fixation (ORIF) with distal femur plating is the optimal surgical approach for right distal 1/3 shaft femur fractures, providing immediate stability and allowing early mobilization to improve patient outcomes.

Preoperative Diagnosis

• Right distal 1/3 shaft of femur fracture

Postoperative Diagnosis

• Right distal 1/3 shaft of femur fracture

Procedure Performed

• Open reduction and internal fixation of right distal 1/3 shaft of femur fracture with 7-hole distal femur plate

Implants Used

• 7-hole distal femur plate
• One 4.5mm cortical screw (38mm)
• Five 5mm locking screws:
  • 34mm (2)
  • 36mm (1)
  • 66mm (1)
  • 70mm (3)

Anesthesia

• General anesthesia

Surgical Technique

Positioning and Preparation

1. Patient positioned supine on radiolucent table
2. Right lower extremity prepped and draped in sterile fashion
3. Fluoroscopy positioned for AP and lateral views of the distal femur

Approach

1. Lateral approach to the distal femur with longitudinal incision centered over fracture site
2. Careful dissection through subcutaneous tissue and fascia lata
3. Vastus lateralis muscle identified and elevated anteriorly to expose the lateral femoral cortex and fracture site

Fracture Reduction

1. Fracture site identified and hematoma evacuated
2. Fracture fragments debrided of soft tissue interposition
3. Anatomic reduction achieved using reduction clamps and confirmed with fluoroscopy
4. Temporary K-wire fixation used to maintain reduction

Implant Application

1. 7-hole distal femur plate positioned on lateral aspect of distal femur
2. Plate position confirmed with fluoroscopy to ensure proper alignment
3. Initial fixation with one 4.5mm cortical screw (38mm) in the shaft portion
4. Distal fixation with five 5mm locking screws:
   • Two 34mm screws placed in distal fragment
   • One 36mm screw placed in distal fragment
   • One 66mm screw placed across fracture site
   • Three 70mm screws placed in proximal fragment for additional stability

Closure

1. Thorough irrigation of the wound
2. Hemostasis achieved
3. Vastus lateralis muscle reapproximated
4. Fascia closed with interrupted absorbable sutures
5. Subcutaneous tissue closed with interrupted absorbable sutures
6. Skin closed with staples
7. Sterile dressing applied

Intraoperative Findings

• Comminuted fracture of the distal 1/3 shaft of right femur
• No significant bone loss
• Good bone quality
• Anatomic reduction achieved
• Stable fixation confirmed with stress testing

Estimated Blood Loss

• 150 mL

Complications

• None

Postoperative Plan

1. Postoperative radiographs confirmed satisfactory reduction and implant position
2. Non-weight bearing on right lower extremity for 6 weeks
3. Early range of motion exercises to begin on postoperative day 1
4. Follow-up in 2 weeks for wound check and suture removal
5. Progressive weight bearing to begin after 6 weeks based on clinical and radiographic healing

Technical Considerations

The combination of a locking plate with interfragmentary screws was chosen to provide optimal stability and promote faster time to full weight bearing 1. This technique has been shown to achieve suitable stability and reduce the risk of nonunion and hardware failure compared to plate fixation alone 1, 2. The 7-hole plate was selected to provide adequate length for proper biomechanical stability, as shorter plate length has been identified as a risk factor for proximal implant failure 2.