LL: DISTAL FEMUR FRACTURES

Question 1

SUPRACONDYLAR FRACTURE OF THE FEMUR pathophysiology and complications

Answer 1

CAUSE
Direct violence
Relatively minor trauma to osteoporotic bone in the elderly
Forced flexion or hyperextension
DEFORMITY
Gastrocnemius pulls the distal fragment into marked posterior angulation
COMPLICATIONS
Popliteal arterial damage
Loss of knee flexion range of motion
Malunion
Non-union

Question 2

SUPRACONDYLAR FRACTURE OF THE FEMUR

Conservative treatment & contraindications and precautions

Answer 2

TREATMENT
These fractures are difficult to treat conservatively as the distal fragment is
very mobile
Conservative Treatment
Skeletal traction through the tibial tuberosity or distal femur (6-8/52). The knee
must remain flexed to about 40° to reduce the pull of gastrocnemius and allow
correction of the deformity. Once off traction, the patient is mobilised PWB
with a brace for 6-8/52 and the FWB with a brace for another 6/52.
CONTRA-INDICATIONS AND PRECAUTIONS
No active or passive knee movement for ±3/52.
No resisted plantar flexion.
No stretches into dorsiflexion for ±3/52.
No combined knee extension with dorsiflexion while on traction.
General contra-indications.

Question 3

SUPRACONDYLAR FRACTURE OF THE FEMUR

Operative treatment & contraindications and precautions

Answer 3

Operative treatment
If the fracture is proximal, a locked intramedullary nail may be used. Usually a
blade plate with screws or a dynamic condylar screw is used. The patients
mobilises NWB.
CONTRA-INDICATIONS AND PRECAUTIONS
No passive movements.
Watch pain with resisted plantar flexion.
Take care with calf stretches.
Initial hip and knee flexion with heel supported.
No SLR until the patient can lock the knee.
Patient can only mobilise once knee can lock.
General contra-indications.

Question 4

INTERCONDYLAR FRACTURES OF THE FEMUR pathophysiology and complications

Answer 4

CAUSE
Usually major trauma

DEFORMITY
Knee is very swollen
May have a varus or valgus deformity

COMPLICATIONS:
AVN
Post-traumatic osteoarthritis
Permanent varus or vaglus deformity
Loss of knee range of motion

Question 5

INTERCONDYLAR FRACTURES OF THE FEMUR

treatment and contraindications

Answer 5

TREATMENT
Depends on the degree of displacement
Undisplaced factures are treated on traction and the regime is similar to that
for supracondylar fractures. The surgeon may insert percutaneous screws to
prevent slippage.
Operative management
Displaced fractures are usually managed with ORIF. Blade plates and screws
and dynamic condylar screws are used.

CONTRA-INDICATIONS AND PRECAUTIONS
No resisted plantar flexion.
NWB until fracture is well healed.
Take care with combined knee extension and dorsiflexion.
No passive movements.
No SLR until the patient can lock the knee.
General contra-indications.

Question 6

CONDYLAR FRACTURES OF THE FEMUR pathophysiology and management

Answer 6

These are isolated fractures of one femoral condyle. The fracture is intraarticular and the treatment of choice is ORIF. Usually screws are used. The
patient is at risk to develop osteoarthritis or a permanent varus or valgus
deformity.
The physiotherapy management is the same as for intercondylar fractures.