Download PDF
OP-Journal 2019; 34(02): 145-155
DOI: 10.1055/a-0755-5681
Fachwissen
Georg Thieme Verlag KG Stuttgart · New York

Distale Femurfrakturen extraartikulär und intraartikulär

Intra- and Extraarticular Distal Femur Fractures
Frank Graef
,
Serafim Tsitsilonis
,
Sven Märdian
Further Information

Publication History

Publication Date:
15 January 2019 (online)

   Permissions and Reprints

Zusammenfassung

Distale Femurfrakturen sind komplexe Verletzungen, die zunehmend bei älteren Patienten auftreten. Trotz moderner Osteosyntheseverfahren treten nach wie vor in über 13% der Fälle Komplikationen auf. Dieser Artikel gibt einen Überblick über Diagnostik, Versorgungsstrategie und mögliche Fallstricke, die bei der Therapie zu beachten sind.

Abstract

Distal femur fractures are rare, however complex injuries which are increasingly observed in the elderly. Despite modern osteosynthesis techniques, complications are reported in over 13% of the cases. This articles gives an overview on diagnostics, treatment and possible pitfalls.

Schlüsselwörter

Femur - Femurfraktur - Fraktur - distale Femurfraktur - distaler Femur - Kniegelenk - Fraktur Knie - Osteosynthese

Key words

femur - femur fracture - fracture - distal femur fracture - distal femur - knee joint - fracture knee joint - osteosynthesis
 

  • Literatur

  • 1 Märdian S, Rau D, Schwabe P. et al. Operative Therapie von distalen Femurfrakturen. Orthopade 2016; 45: 32-37
    CrossrefPubMedGoogle Scholar
  • 2 Heim UF. [Defining the boundary between diaphysis and metaphysis using quadrant measurement. A contribution to the classification and documentation of fractures of long tubular bones exemplified by the distal tibia]. Unfallchirurg 1987; 90: 274-280
    PubMedGoogle Scholar
  • 3 Schatzker J, Lambert DC. Supracondylar fractures of the femur. Clin Orthop Relat Res 1979; (138) 77-83
    PubMedGoogle Scholar
  • 4 Elsoe R, Ceccotti AA, Larsen P. Population-based epidemiology and incidence of distal femur fractures. Int Orthop 2018; 42: 191-196
    CrossrefPubMedGoogle Scholar
  • 5 Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury 2006; 37: 691-697
    CrossrefPubMedGoogle Scholar
  • 6 Ehlinger M, Ducrot G, Adam P. et al. Distal femur fractures. Surgical techniques and a review of the literature. Orthop Traumatol Surg Res 2013; 99: 353-360
    CrossrefPubMedGoogle Scholar
  • 7 Blumensaat C. Die Lageabweichungen und Verrenkungen der Kniescheibe. Ergebn Chir Orthop 1938; 31: 149-223
    PubMedGoogle Scholar
  • 8 Collinge CA, Wiss DA. Distal Femur Fractures. In: Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. eds. Rockwood and Greenʼs Fractures in Adults. Philadelphia: Lippincott Williams & Wilkins; 2014
    Google Scholar
  • 9 Butt WP, Samuel E. Radiologic anatomy of the proximal end of the femur. J Can Assoc Radiol 1966; 17: 103-106
    PubMedGoogle Scholar
  • 10 Luo CF. Reference axes for reconstruction of the knee. Knee 2004; 11: 251-257
    CrossrefPubMedGoogle Scholar
  • 11 Hsu RW, Himeno S, Coventry MB. et al. Normal Axial Alignment of the Lower Extremity and Load-Bearing Distribution at the Knee. Clin Orthop Relat Res 1990; 255: 215-227
    PubMedGoogle Scholar
  • 12 Matsuda S, Miura H, Nagamine R. et al. Posterior tibial slope in the normal and varus knee. Am J Knee Surg 1999; 12: 165-168
    PubMedGoogle Scholar
  • 13 Schünke M, Schulte E, Schumacher U. Prometheus LernAtlas der Anatomie. Allgemeine Anatomie und Bewegungssystem. Stuttgart: Thieme; 2014
    Google Scholar
  • 14 Bertin KC, Goble EM. Ligament injuries associated with physeal fractures about the knee. Clin Orthop Relat Res 1983; (177) 188-195
    PubMedGoogle Scholar
  • 15 Muñoz Vives J, Bel J-C, Capel Agundez A. et al. The floating knee: a review on ipsilateral femoral and tibial fractures. EFORT Open Rev 2017; 1: 375-382
    CrossrefPubMedGoogle Scholar
  • 16 Emami Meybodi MK, Ladani MJ, Emami Meybodi T. et al. Concomitant ligamentous and meniscal knee injuries in femoral shaft fracture. J Orthop Traumatol 2014; 15: 35-39
    CrossrefPubMedGoogle Scholar
  • 17 Nork SE, Segina DN, Aflatoon K. et al. The association between supracondylar-intercondylar distal femoral fractures and coronal plane fractures. J Bone Joint Surg Am 2005; 87: 564-569
    CrossrefPubMedGoogle Scholar
  • 18 Jens S, Kerstens MK, Legemate DA. et al. Diagnostic Performance of Computed Tomography Angiography in Peripheral Arterial Injury due to Trauma: A Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2013; 46: 329-337
    CrossrefPubMedGoogle Scholar
  • 19 Patterson BO, Holt PJ, Cleanthis M. et al. London Vascular Injuries Working Group. Imaging vascular trauma. Br J Surg 2012; 99: 494-505
    CrossrefPubMedGoogle Scholar
  • 20 Wallin D, Yaghoubian A, Rosing D. et al. Computed Tomographic Angiography as the Primary Diagnostic Modality in Penetrating Lower Extremity Vascular Injuries: A Level I Trauma Experience. Ann Vasc Surg 2011; 25: 620-623
    CrossrefPubMedGoogle Scholar
  • 21 Weight M, Collinge C. Early results of the less invasive stabilization system for mechanically unstable fractures of the distal femur (AO/OTA types A2, A3, C2, and C3). J Orthop Trauma 2004; 18: 503-508
    CrossrefPubMedGoogle Scholar
  • 22 Dugan TR, Hubert MG, Siska PA. et al. Open supracondylar femur fractures with bone loss in the polytraumatized patient – Timing is everything!. Injury 2013; 44: 1826-1831
    CrossrefPubMedGoogle Scholar
  • 23 Butt MS, Krikler SJ, Ali MS. Displaced fractures of the distal femur in elderly patients. Operative versus non-operative treatment. J Bone Joint Surg Br 1996; 78: 110-114
    PubMedGoogle Scholar
  • 24 Jahna H, Wittich H. Konservative Methoden in der Frakturbehandlung. München: Urban & Schwarzenberg; 1985
    Google Scholar
  • 25 Moore TJ, Watson T, Green SA. et al. Complications of surgically treated supracondylar fractures of the femur. J Trauma 1987; 27: 402-406
    CrossrefPubMedGoogle Scholar
  • 26 Merchan EC, Maestu PR, Blanco RP. Blade-plating of closed displaced supracondylar fractures of the distal femur with the AO system. J Trauma 1992; 32: 174-178
    CrossrefPubMedGoogle Scholar
  • 27 Kayali C, Agus H, Turgut A. Successful results of minimally invasive surgery for comminuted supracondylar femoral fractures with LISS: comparative study of multiply injured and isolated femoral fractures. J Orthop Sci 2007; 12: 458-465
    CrossrefPubMedGoogle Scholar
  • 28 Märdian S, Schaser KD, Duda GN. et al. Working length of locking plates determines interfragmentary movement in distal femur fractures under physiological loading. Clin Biomech (Bristol, Avon) 2015; 30: 391-396
    CrossrefPubMedGoogle Scholar
  • 29 Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002; 84: 1093-1110
    CrossrefPubMedGoogle Scholar
  • 30 Augat P, von Rüden C. Evolution of fracture treatment with bone plates. Injury 2018; 49: S2-S7
    PubMedGoogle Scholar
  • 31 Forsythe B, Kopf S, Wong AK. et al. The location of femoral and tibial tunnels in anatomic double-bundle anterior cruciate ligament reconstruction analyzed by three-dimensional computed tomography models. J Bone Joint Surg Am 2010; 92: 1418-1426
    CrossrefPubMedGoogle Scholar
  • 32 Kramer DE, Miller PE, Berrahou IK. et al. Collateral Ligament Knee Injuries in Pediatric and Adolescent Athletes. J Pediatr Orthop 2017; DOI: 10.1097/BPO.0000000000001112.
    CrossrefPubMedGoogle Scholar
  • 33 Farber A, Tan TW, Hamburg NM. et al. Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: A review of the National Trauma Data Bank. Injury 2012; 43: 1486-1491
    CrossrefPubMedGoogle Scholar
  • 34 Buckley R, Moran C, Apivatthakakul T. AO Principles of Fracture Management. Stuttgart: Thieme; 2018
    Google Scholar
  • 35 Hoppenfeld S, de Boer P, Buckley R. Surgical Exposures in Orthopaedics. The anatomic Approach. 5th ed. Alphen aan den Rijn: Wolters Kluwer; 2017
    Google Scholar
  • 36 Bliemel C, Bücking B, Ruchholtz S. Distale Femurfrakturen. Orthopädie und Unfallchirurgie up2date 2017; 12: 63-84
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Märdian S, Schmölz W, Schaser KD. et al. Interfragmentary lag screw fixation in locking plate constructs increases stiffness in simple fracture patterns. Clin Biomech (Bristol, Avon) 2015; 30: 814-819
    CrossrefPubMedGoogle Scholar
  • 38 Chung JY, Cho JH, Kweon HJ. et al. The use of interfragmentary positional screw in minimally invasive plate osteosynthesis for simple distal femur fractures in elderly patients: A retrospective, single-centre pilot study. Injury 2016; 47: 2795-2799
    CrossrefPubMedGoogle Scholar
  • 39 Hill AD, Palmer MJ, Tanner SL. et al. Use of Continuous Passive Motion in the Postoperative Treatment of Intra-Articular Knee Fractures. J Bone Joint Surg Am 2014; 96: e118
    CrossrefPubMedGoogle Scholar
  • 40 Langenhan R, Baumann M, Ricart P. et al. Postoperative functional rehabilitation after repair of quadriceps tendon ruptures: a comparison of two different protocols. Knee Surg Sports Traumatol Arthrosc 2012; 20: 2275-2278
    CrossrefPubMedGoogle Scholar
  • 41 Zlowodzki M, Bhandari M, Marek DJ. et al. Operative treatment of acute distal femur fractures: systematic review of 2 comparative studies and 45 case series (1989 to 2005). J Orthop Trauma 2006; 20: 366-371
    CrossrefPubMedGoogle Scholar