Extra Articular Distal Femur Fractures
Habib Olapade
UK pre law student; Falsely imprisoned in TX intending to move to CA, HI, or UK upon release.
These fractures involve the distal metaphysis and epiphysis of the femur. Here, the distal fragment is usually rotated into extension from traction provided by the gastrocnemius muscle. The distal end of the proximal fragment can be predisposed to perforate the overlying quadriceps and penetrate the suprapatellar pouch causing hemarthrosis. Because the distal fragment can impinge on the popliteal neurovascular bundle, an immediate and thorough neurovascular exam is required. The absence or marked decrease of pedal pulsations is an indication for immediate reduction. If this fails to restore adequate circulation, an arteriogram should be obtained, and the vascular lesion should be repaired. Injuries to the tibial or peroneal nerves are less frequent. For simple fracture patterns, closed reduction under general anesthesia is usually successful. Most of these fractures, though, are best treated with internal fixation which facilitates early mobilization for the patient’s neighboring joints. Therapy that includes fixed angle plates, MIPO, and retrograde intramedullary nailing is also recommended. Skeletal traction treatment is reserved for patients for whom surgery is contraindicated and can have many complications.