Open Reduction and Internal Fixation (ORIF) of Distal Femoral Fractures

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  • Type A: extraarticular fractures of the distal femoral metaphysis
    • 95-degree blade plate
    • Condylar screw
    • Locking plate
    • IM nail
  • Type B: partial articular fractures
    • B1 lateral condyle fractures and B2 medial condyle fractures
      • Interfragmentary lag screws
        • Supplementation of buttress screw or buttress plate if fracture extends to the proximal metaphysis or distal diaphysis
    • B3 coronal fractures
      • Interfragmentary lag screws
  • Type C: complete articular fractures
    • Intraarticular component should have fixation with interfragmentary lag screws
    • The extraarticular component can be fixed with:
      • 95-degree blade plate
      • Condylar screw
      • Locking plate
      • IM nail
  • Almost universally, supracondylar fractures of the femur require open reduction and stable internal fixation.
  • Severe medical comorbidities that prevent operative management represent relative contraindications.
  • Large fragment set
  • Small fragment set, if required
  • Fixation device depending on preoperative planning
    • Locking condylar plate
      • Locking compression plate (LCP) plating system
      • Large distractor set
      • Basic percutaneous instrument set
      • 4.5-mm cannulated screw instrument and implant set
      • 6.5-mm/7.3-mm combined cannulated screw instrument and implant set
      • Fluoroscopy unit
  • Bone
    • The condyles are wider posteriorly.
      • The lateral wall inclines 10 degrees.
      The medial wall inclines 25 degrees<./li>
    • Bony alignment
      • The anatomic axis has valgus angulation of 9 degrees.
  • Soft tissue
    • The superficial femoral artery runs down the medial aspect of the thigh between the extensor and adductor compartments.
    • It passes into the popliteal fossa approximately 10 cm above the knee joint.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Early passive motion with some active motion is begun as tolerated.
  • No weight-bearing activity for 3 months.
    • Active and passive range of motion should be encouraged during this time.
  • Incongruency of joints secondary to reduction
    • This can lead to posttraumatic osteoarthritis.
  • Synovitis and knee pain
  • Infection
  • Malunion and nonunion

Early results have been encouraging, but rigorous trials have yet to be performed.

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