Femur, distal: intraarticular fracture—33-C3
Case description
A 54-year-old woman was hit by a motor vehicle while walking. She had a left multifragmentary distal femoral fracture with fracture lines extending into the medial and lateral femoral condyles in the coronal plane (Hoffa fracture). Plain x-ray revealed sufficient information about the injury, therefore a CT scan was not performed.
Indication for MIPO
There is clear indication for operative treatment of the displaced intraarticular fractures and the most appropriate method is by plate fixation. Retrograde intramedullary nailing is not appropriate because of the short and multiplanar articular fragments. Anatomical reduction of the articular fracture should be performed with direct reduction, followed by indirect reduction of the multifragmentary fracture of the distal femoral metaphyseal area. Minimally invasive plate osteosynthesis using an LCP-DF would be appropriate in this situation.
Preoperative planning
Definitive fixation was performed 5 days after initial trauma when the patient was in a stable general condition. A preoperative plan by drawing the fractures is recommended, including the surgical approach, the applied reduction techniques, and the selected implant ( Fig 18.6-2 ).
Operating room setup
Anesthesia
This patient was administered general anesthesia.
Patient and image intensifier positioning
The patient is placed in the supine position on a radiolucent table with the uninjured leg dropped down to facilitate the lateral x-ray ( Fig 18.6-3a ). A bolster is placed under the injured knee ( Fig 18.6-3b ). In this patient the lateral cortex of the fracture was used as the guide to determine correct leg length. In case of segmental comminuted fractures, preparation of both lower limbs is recommended to compare and determine length. The image intensifier is positioned on the contralateral side.
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