distal femur fracture case

• Yes
• No

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• Lateral locking plate. It’s transverse and stable, so should do fine with one plate.
• Antegrade nail. I prefer not violating the knee and this has enough to fix into distally.
• Retrograde nail. I prefer not violating the hip abductors and you’ll get a lovely fix on this distal block
• Plate and nail or two plates. Give him bullet-proof fixation for immediate unrestricted weight bearing.

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• Looks lovely. That’s almost exactly what I would have done. Nice job, gonna heal famously
• Not what I’d have done but looks ok. Provided there was minimal stripping, it’ll probs go on to heal ok.
• Booooo! It’s way too rigid. Callus won’t form quick enough and the 3-4month Xray will have broken hardware
• Rubbish! Simply not strong enough. It needed a second plate. Gonna fall into varus or bust the plate
• Terrible! This is a shaft fracture and so needed a nail. Totally wrong choice of implant. Plate’s gonna break or bend.

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• True
• False

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• Lateral locking plate. It looks like a spiral butterfly, so I might open the fracture and cable it back together to get it perfect before plating.
• Distal femur replacement. She’s fit and well for her age and able to take the surgery. DFR provides immediate safe-weight bearing and will serve her for life. Resection level will need to be high b
• Two plates. One plate simply isn’t enough to confidently weight-bear afterwards (even with cables) so fix both columns and weight bear as tolerated.
• Plate and nail. Assuming this TKR allows it (and it looks like it will) I’d nail this retrograde and then reinforce with a lateral locking plate, or maybe vice versa.
• Retrograde nail. On axis fixation is strong enough here and 2-implants makes it stiff and slow to heal.

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• It’s minimally displaced. I’d clamp percutaneously and if X-rays look ok, I’d fix it there
• I’m opening the fracture anyway, so open reduction - medial para-patellar approach
• I’m opening the fracture anyway, so open reduction - lateral para-patellar approach
• Mini-open approach to the joint and separate incision(s) for the rest of the fixation

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• Lateral locking plate with some inter-frag screws to hold the joint. The lateral cortex looks like it will key-in nicely. No further fixation needed
• Two plates. A medial buttress plate will pick up that apex very nicely, and thereby augment the lateral plate fixation.
• Retrograde nail. After fixing the split, I’d leave a clamp across the condyles while getting my entry-point. The bone quality is great, so my 2-locking screws will give ample stability here.
• Nail and medial plate. The bone quality is good but the fracture’s very distal. I’d supplement the nail with a medial buttress plate to hold that apex.
• Nail and lateral plate. As above but a lateral locking plate is way easier to put on. I might lock my nail medial to lateral, so they don’t get incarcerated by the plate.

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