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The first 25 slides, exactly as they appear. The full deck has 94 content slides.
Orthopaedics
Distal Femoral Fractures
Built from Tang — Orthopaedic Trauma Vol 2: Lower Extremity
What’s inside
11 sections · 94 slides
Overview
- What this deck will teach you
Foundations
What the injury is, and the anatomy that governs its repair
- What is a distal femoral fracture?
- Distal femoral fractures by the numbers
- The shape of the bone end explains the screws
- End-on trapezoidal shape and screw angles
- Side view: why plates sit on the front half
- Lateral view: correct plate and DCS position
- Two weak spots, and the limb's axes
- Femoral axes and the knee's valgus angle
- Restore the valgus, or the knee pays later
- Why the broken pieces will not stay put
- Deforming muscle forces and reduction aids
- The danger behind the knee: vessels and nerves
- Neurovascular anatomy of the popliteal fossa
Mechanism & Classification
How the bone breaks, and the language surgeons use to describe it
- How the force reaches the bone
- Injury mechanism of the fracture
- The AO classification: A, B, C
- Type A - extra-articular (joint surface spared)
- Type B - partial articular (one facet split off)
- Type C - complete articular fracture
- AO Type A - extra-articular
- AO Type B - partial intra-articular
- AO Type C - complete intra-articular
- Radiograph of a Type C3.2 distal femur fracture
Assessment
Reading the limb and the images before you operate
- Clinical assessment at the bedside
- Never miss the vessels and nerves
- Imaging: from plain films to CT
- A missed coronal (Hoffa) fracture on plain film
- Popliteal artery compressed by the distal fragment
Surgical Treatment
Indications, positioning, and the operative approaches
- Who gets surgery, and why
- Positioning on the table
- Supine positioning of the injured limb
- Choosing the surgical approach
- Standard lateral approach to the distal femur
- Minimally invasive lateral approach
- Parapatellar tendon approach
- Medial approach to the distal femur
- Picking the fixation: how close to the joint?
- How close each implant sits to the joint
- Compression vs bridging, nail vs plate
Partial-Articular (Type B) Fractures
Single-condyle and Hoffa fractures
- Reducing and fixing B1 and B2 fractures
- Reduction and lag-screw fixation of a B1/B2 fracture
- B1/B2 fixation - fluoroscopic detail
- The Hoffa fracture (B3.2-3.3): back-of-condyle splits
- Lag-screw fixation of a Hoffa fracture
- Hoffa fracture fixation - screw and radiograph detail
Complete-Articular Type C
Rebuild the joint, then reconnect it to the shaft
- Strategy: turn a Type C into a Type A
- Reduction and fixation of the articular surface
- Reconnecting the block to the shaft: the DCS
- DCS guide-wire and screw placement
- Complex metaphysis: LISS bridge plating
- Inserting and aligning the LISS plate
- LISS plating - rotation control and fixation
- Confirming length, axis and rotation
- Healed Type C3 fracture after lag screws and LISS
- Postoperative care
Experience & Lessons
The mistakes that fail a fixation, and the biology of healing
- Mistake 1: eccentric proximal screws
- Eccentric fixation and its failure
- Mistake 2: ignoring the medial column
- Type C2 fracture with LISS and medial buttress
- The biology: why over-stiff plates can stall healing
- Far cortical locking screw designs
Retrograde Intramedullary Nailing
A rod up the marrow cavity, and the trick of blocking screws
- When to choose the nail
- Set-up: fix the joint, then pass the nail
- Convert Type C to Type A, then nail
- Retrograde nailing of a Type C2.2 fracture
- The logic of blocking (Poller) screws
- How blocking screws steer the nail
- Locking the nail, and improving its grip
- Nails engineered for anti-rotation
- The ASLS angular stable locking system
Complications & Prevention
Malunion, nonunion, and vascular injury
- Malunion: the bone heals crooked
- Malunion after LISS with a varus deformity
- Malunion after poor sagittal reduction
- Nonunion: the bone fails to bridge
- Repeated fixation failure without medial support
- Nailing complications and vascular injury
Summary
The essentials in one place
- Three ideas to carry away
- Why must a Type C distal femoral fracture be reduced in a set order, and what is that order?
- References (1/3)
- References (2/3)
- References (3/3)
- Orthopaedic Trauma Surgery - Volume 2: Lower Extremity