fracture of distal femur

RE: fracture of distal femur

Malcolm Ness — Wed, 25 May 2016 06:02:58 GMT

As with most fractures, there are a number of valid treatment options. Previous posters are right to point out that this is mechanically different from the typical distal femoral fracture through the physics. Similarly, that this is not a simple two-piece break adds to the complexity.

A good locking plate (applied to lateral aspect with two screws in distal fragment), ideally with a small ints-medullary pin would probably be the best option assuming that cost and surgeon-skill are not issues.

Several other techniques could be expected to work. Classic Rush pins extending across the fracture and well up into the femur will work nicely but this is a challenging technique.

The distal fragment is just big enough to take a simple IM pin but that would need to be supplemented with a simple Ex-Fix to afford adequate stability.

A little-used technique that would be applicable here is stack-pinning - the use of three small intra-medullary pins. The technique gives good stability though it is technically more challenging than it appears at first and the proximal ends of the pins cause significant discomfort/irritation and usually have to be removed.

A shaped bone plate - the hockey stick shaped implants could be made but that will involve considerable dissection involving the stifle joint and consequently some inevitable long-term morbidity.

RE: fracture of distal femur

Fiona French — Tue, 24 May 2016 15:26:10 GMT

Crossed K wires or rush pins work fine for distal femoral growth plate fractures, which have good inherent stability when reduced. This is well above the condyles and not fully constructible due to the fragments, will have no inherent stability, and k wires or rush pins will not neutralise the forces acting in it, which will be mainly rotation and bending. I would use a supracondylar (hockey stick) plate laterally, possibly even coupled with an IM pin as the plate would essentially be in bridging mode and taking all of the forces.

RE: fracture of distal femur

Robin Grimmer — Tue, 24 May 2016 10:48:29 GMT

How about a lag screw?

Also, what size animal is this?

RE: fracture of distal femur

grumpyoldman — Mon, 23 May 2016 22:39:47 GMT

[quote user="Dinu Catilina"]With this fracture not being through the growth plate and I would consider using an IM pin and a plate on the lateral aspect. I would also use a locking system.[/quote]

ditto : thought about rush pins as well

RE: fracture of distal femur

Dinu Catilina — Mon, 23 May 2016 22:24:18 GMT

With this fracture not being through the growth plate and I would consider using an IM pin and a plate on the lateral aspect. I would also use a locking system.

RE: fracture of distal femur

Beats — Mon, 23 May 2016 20:53:56 GMT

See: https://www.vetsurgeon.org/uk/small_animal/f/9/t/5683.aspx?pi1596=1#22315

for a description of techinque from Malcolm Ness

(hope I've go the link to work correctly!)

EDIT: Looking at your xrays the extra cranial fragment might mean not so stable when you reduce it...

RE: fracture of distal femur

Ruta — Mon, 23 May 2016 14:50:23 GMT

Thank you, Robin, I was thinking about this technique too. It should be a good choice.

RE: fracture of distal femur

Robin Grimmer — Mon, 23 May 2016 13:03:39 GMT

I think cross wires would be fine but I would use im pins rather than k wires.