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DISTAL FEMORAL FRACTURE

POB/DOM/YSW/AFR
MOI

Axial load with a varus, valgus, or rotational force.


In young patients, this amount of force is typically the result of high-energy trauma such as motor vehicle
collisions and falls from heights.
In elderly patients, the force from a minor slip and fall on a flexed knee may be sufficient to produce these
fractures
BIOMECHANISM

The objective of Within the condyles, compressive


strength, elastic modulus and apparent density increase
from the proximal parts to the parts closer to the
joint

The medial femoral condyle showed higher


compressive strength than the lateral one

the mechanical properties of cancellous


bone are strongly related to the direction of loading.

this study was to obtain data of the


material properties which are required for calculations
of stress applied to the bone and for optimal fixation of
endoprostheses.
BASIC SCIENCE

The supracondylar area of the femur is defined as the zone between the femoral condyles and the junction
of the metaphysis with the femoral shaft. This area comprises the distal 9 to 15 cm of the femur
ANATOMY
BONE

• 2 Condyle
• Has a shallow articular depression for articulation with
patella
• The lateral condyle is broader than the medial condyle. The
outer surface of the lateral condyle is almost flat, but an
epicondyle on its surface gives attachment to the fibular
collateral ligament.
• The medial condyle is longer and extends farther distally
than the lateral condyle. The outer surface of the medial
condyle is convex, and an epicondyle on its surface gives
attachment to the medial collateral ligament. On the
proximal medial surface of the medial condyle is the
adductor tubercle, to which the adductor magnus muscle
inserts

Normally, the knee joint is parallel to the ground. On average,


the anatomic axis (the angle between the shaft of the femur
and the knee joint) has a valgus angulation of 9 degrees
SOFT TISSUE

• Anterior to the femur is the quadriceps femoris muscle,


consisting of four heads (the rectus femoris, the vastus
medialis, the vastus intermedius, and the vastus lateralis)
• The femoral artery passes into the popliteal fossa
approximately 10 cm above the knee joint It passes through
the adductor magnus muscle proximal to the insertion of
that muscle into the adductor tubercle
PHYSICAL EXAMINATION
• PRIMARY SURVEY ( A B C D E ) “ Supracondylar fractures of the femur are often the result of
• SECONDARY SURVEY high-energy trauma. Therefore, a complete evaluation of the
whole patient should be performed ”
• Head to toe
“ The presence of other injuries to the same extremity needs to
• Local State: L, F, M
be ruled out, with particular attention to the hip and the leg
below the fracture site. The vascular supply to the limb should
be assessed by examining for the presence of a pulse at the
popliteal, dorsalis pedis, and posterior tibial arteries. Motor
and sensory function to the leg and foot must be assessed ”
“ Inspection usually shows swelling and deformity around the
distal femur and knee. The presence of an open wound in the
case of open fractures should be identified “

As a part of and immediately after the physical examination, the injured extremity should be gently realigned (if
necessary) and splinted before x-ray evaluation
•X-rays FEMUR AP/LAT, GENU AP/LAT
RADIOGRAPHIC EVALUATION The most common way to evaluate a fracture is with
x-rays, which provide clear images of bone. X-rays
can show whether a bone is intact or broken. They
can also show the type of fracture and where it is
located within the femur. To make sure no other
•Computed tomography (CT) scan. A CT scan shows a breaks are missed, your hip and ankle joints will also
cross-sectional image of limb. It can provide a valuable be x-rayed.
information about the severity of the fracture. This scan
can show whether the fracture enters the joint surface
and, if so, how many pieces of bone there are. A CT scan
will help us decide how to fix the break.

“ Other tests. Your doctor may order other tests that do


not involve the broken leg to make sure no other body
parts are injured (head, chest, belly, pelvis, spine, arms,
and other leg). Sometimes, other studies are done to
check the blood supply to your leg”
DIFFERENTIAL DIAGNOSE

• Fracture of the 1/3 distal shaft


• Supracondyle fracture
• Intercondyle fracture
• Fracture of the patella
• Softtissue injury around the knee
• Or combination
CLASSIFICATION
COMMUNICATION SKILL

• Tell the patient clearly about their injury


• Make sure they understand ( repeat it )
• Tell all the diagnostic modality
• Tell about the therapy
• Tell about the complications