Operative Treatment of Acute Distal Femur Fractures: Systematic Review of 2 Comparative Studies and 45 Case Series (1989 to 2005)

• Published in: Journal of orthopaedic trauma Vol. 20; no. 5; pp. 366 - 371
• Main Authors: Zlowodzki, Michael, Bhandari, Mohit, Marek, Daniel J, Cole, Peter A, Kregor, Philip J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-05-2006; Lippincott Williams & Wilkins
• Subjects: Adult; Biological and medical sciences; Diseases of the osteoarticular system; Femoral Fractures - surgery; Fracture Fixation - methods; Humans; Injuries of the limb. Injuries of the spine; Knee Injuries - surgery; Medical sciences; Middle Aged; Traumas. Diseases due to physical agents; Treatment Outcome; Internal fixation; Femur; Prognosis; Diseases of the osteoarticular system; Review; Epidemiology; Mechanism; Incidence; Intercondylar fracture; Supracondylar fracture; Female; Woman; Human; Pseudoarthrosis; Open reduction; distal femur fracture; Acute; meta-analysis; Osteosynthesis; supracondylar femur fracture; systematic review; Surgeon; Low energy; Case study; Treatment; Screw; High energy; intercondylar femur fracture; External; Elderly; evidence-based; Comparative study; Bibliographic review
• ISSN: 0890-5339; 1531-2291
• DOI: 10.1097/00005131-200605000-00013

BACKGROUNDThe incidence of distal femur fractures is approximately 37 per 100,000 person-years. Typically, distal femur fractures are caused by a high-energy injury mechanism in young men or a low-energy mechanism in elderly women. Managing these fractures can be a challenging task. Most surgeons agree that distal femur fractures need to be treated operatively to achieve optimal patient outcomes. The articular fracture component is usually treated with open reduction and internal lag screw fixation or external tension wire fixation (Illizarov). However, there is no consensus on the type of implant for the fixation of the metaphyseal–diaphyseal fracture component.
OBJECTIVEThe aim of this study is to systematically summarize and compare the results of different fixation techniques (traditional compression plating, antegrade nailing, retrograde nailing, submuscular locked internal fixation, and external fixation) in the operative management of acute nonperiprosthetic distal femur fractures (AO/OTA type 33A and C) and the characteristics of the fractures for each treatment (articular/nonarticular and open/closed). Additionally an attempt was made to evaluate the impact of surgical experience on nonunion rate, fixation failure rate, deep infection rate, and secondary surgical procedure rate. In the context of this article compression plating relates to techniques/implants that require compression of the implant to the femoral shaft—it does not relate to interfragmentary compression.