Distal Femur Fractures

For uncomplicated fracture healing, approach and fracture reduction technique need to be minimized during surgery in order to reduce iatrogentic soft tissue damage. Choice of treatment in distal femoral fractures depends on fracture pattern and surgical experience. Various first generation implants (condylar blade plate, condylar buttress plate, dynamic condylar screw [DCS], fork plate, retrograde nail) for open or closed reduction and internal fixation have been specifically developed for distal femoral fractures, reflecting varying needs in this anatomical area. With the better awareness of biological factors affecting fracture healing in the 1990s, treatment concepts have moved towards minimally invasive approaches and plates with locked screws for intra-articular fractures. The TARPO approach is nowadays the gold standard for the articular fractures, while the direct lateral approach is the approach of choice for extraarticular fracture fixation using locked plates. Retrograde nails are a good solution for extraarticular fractures and fractures in the elderly population. Primary distal femoral replacement arthroplasty has emerged as a viable option for the management of distal femoral fractures in the elderly population where high levels of comminution due to osteoporotic bone may jeopardize traditional fixation techniques.With these concepts, healing complications and other problems have significantly decreased. However, minimally invasive plating techniques have a risk for fracture malalignment. In this chapter, details in regards to decision-making algorithms and up-to-date techniques for preoperative planning, patient positioning, fracture reduction, and prevention of complications are described for both, locked plating and retrograde nailing.