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Background <p>Distal femur fractures remain a&#xa0;demanding clinical problem for both surgeons and patients. Treatment options range from osteosynthesis with open reduction and internal fixation (ORIF) to primary total knee arthroplasty (TKA) and distal femoral replacement (DFR). In daily practice, however, decisions are often based on a&#xa0;combination of fracture characteristics and patient-related factors, and a&#xa0;concise overview that considers the full therapeutic spectrum has not yet been presented.</p> Objective <p>To summarize the key patient-, fracture-, and joint-related factors that influence the decision between ORIF and arthroplasty in a&#xa0;clinically applicable manner.</p> Methods <p>A&#xa0;structured narrative review of the literature was performed focusing on indications, reported outcomes, and postoperative weight-bearing concepts. Relevant patient-, fracture-, and implant-related criteria were identified. The review was conducted with input from centers experienced in both trauma and arthroplasty surgery.</p> Results <p>Across the available literature, the decision between ORIF and arthroplasty is most consistently influenced by four main aspects: the reconstructability of the articular surface, the possibility of stable metaphyseal fixation, the biological and functional profile of the patient, and the condition of the joint, particularly the presence of pre-existing osteoarthritis. In selected situations where reliable reconstruction is unlikely, distal femoral replacement may serve as a&#xa0;salvage option.</p> Conclusion <p>The presentation of these factors in a&#xa0;concise table may help to structure the decision-making process in treatment of distal femur fractures and facilitate interdisciplinary discussion. Such an overview cannot replace individual clinical judgement but may serve as a&#xa0;practical reference when weighing reconstructive and arthroplasty-based treatment strategies.</p>

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Operative Behandlungsstrategien bei distalen Femurfrakturen: Was und wann?

  • 期刊论文

  • 发表日期：

    2026年4月8日

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  • C. Horst,
  • J. Rieger,
  • P. Buschner,
  • E. Röhner,
  • M. T. Hirschmann,
  • J. Beckmann

摘要

Background

Distal femur fractures remain a demanding clinical problem for both surgeons and patients. Treatment options range from osteosynthesis with open reduction and internal fixation (ORIF) to primary total knee arthroplasty (TKA) and distal femoral replacement (DFR). In daily practice, however, decisions are often based on a combination of fracture characteristics and patient-related factors, and a concise overview that considers the full therapeutic spectrum has not yet been presented.

Objective

To summarize the key patient-, fracture-, and joint-related factors that influence the decision between ORIF and arthroplasty in a clinically applicable manner.

Methods

A structured narrative review of the literature was performed focusing on indications, reported outcomes, and postoperative weight-bearing concepts. Relevant patient-, fracture-, and implant-related criteria were identified. The review was conducted with input from centers experienced in both trauma and arthroplasty surgery.

Results

Across the available literature, the decision between ORIF and arthroplasty is most consistently influenced by four main aspects: the reconstructability of the articular surface, the possibility of stable metaphyseal fixation, the biological and functional profile of the patient, and the condition of the joint, particularly the presence of pre-existing osteoarthritis. In selected situations where reliable reconstruction is unlikely, distal femoral replacement may serve as a salvage option.

Conclusion

The presentation of these factors in a concise table may help to structure the decision-making process in treatment of distal femur fractures and facilitate interdisciplinary discussion. Such an overview cannot replace individual clinical judgement but may serve as a practical reference when weighing reconstructive and arthroplasty-based treatment strategies.