Femur, distal: intraarticular fracture—32-C3/33-C3

10.1055/b-0034-87647

Femur, distal: intraarticular fracture—32-C3/33-C3

Reto Babst

Case description

A 46-year-old man was hit by a motor vehicle while riding his bicycle. He had craniomaxillofacial and cerebral injuries (GSC 12), fractures of the thoracic vertebral bodies 2–4, including a sternal fracture, and a second degree open multifragmented left distal femoral shaft fracture with fracture lines extending into the lateral femoral condyle ( Fig 18.5-1 ). Initial treatment of the femoral fracture included a joint-spanning external fixator with debridement of the open wound and release of the lateral femoral compartment while the skin was open.

Indication for MIPO

The patient was stabilized for his concomitant injuries and needed internal fixation for the articular and shaft fractures. A MIPO procedure either with a plate or a nail would be appropriate in this situation. The extramedullary approach using an LCP-DF was chosen because of the intraarticular fractures, so as not to interfere with distal locking when using a nail.

a–d Left distal femoral multifragmented spiral fracture involving the lateral femoral condyle.

Preoperative planning

A hand-drawn or computer-generated preoperative plan is recommended, including the approach, the applied reduction techniques, and the selected implant ( Fig 18.5-2 ). The definitive fixation was performed 6 days after initial trauma when the patient‘s general condition had stabilized and there was normalization of compartment pressure.