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PubMed1998

[Distal femoral fractures].

Techniques of operative treatment of supra- and intercondylar fractures have changed in recent years. These changes refer to reduction techniques and implant selection. Operative approach concepts, which remained unchanged for several decades were critically evaluated and modified to a minimal invasive osteosynthesis [MIO]. This included for intraarticular fractures a trans-articular joint reconstruction and a retrograde plate osteosynthesis (TARPO). This technique result in better operative visualization and management of intraarticular comminution, saver fracture healing and better functional outcome. For extraarticular fractures a minimally invasive percutaneous plate osteosynthesis (MIPPO) via stab incisions only or retrograde intramedullary nailing is available. Beside that new strategies and techniques for the avoidance of axial malalignment, rotational deformities and leg length discrepancies are described, as well as a new plate generation (LISS: less invasive stabilization system), which behaves more like an internal fixator. The complex nature of combined fractures and soft tissue injuries of the distal femur and proximal tibia needs special attention and specific management. Distal femoral and proximal tibial fractures in young patients are usually caused by a high energy trauma. They are complicated by a high rate of systemic and local injuries to cartilage, ligaments and skin. The patients in this group with severe injuries need a detailed treatment algorithm, because the surgeon's individual skill, enthusiasm and wishful thinking frequently led to unsatisfactory results. A decision making scheme is presented specifically addressing timing and treatment modalities.

Equipment Design↗
PubMed1994

Treatment of femoral fracture above a knee prosthesis. 18 cases followed 0.5-14 years.

We reviewed 16 patients who sustained 18 fractures above a total knee prosthesis. 5 fractures were undisplaced and were treated with either skeletal traction or a plaster cylinder. 3 did well, 1 patient suffered a cerebral vascular accident while still in plaster and 1 patient died of heart failure while on skeletal traction. 7 displaced fractures were treated initially with skeletal traction. 1 patient had a nonunion of the fracture and 2 a malunion and malfunction of the knee. 4 underwent various operations later because of malalignment and nonunion of the fracture with poor functional results. 6 displaced fractures were treated with immediate internal fixation. 5 recovered well and returned to pre-fracture activities. 1 patient's plate broke and further surgery was needed. We conclude that displaced fractures above a knee prosthesis should be treated with immediate stable internal fixation and early mobilization. Nonoperative treatment was satisfactory only for minor undisplaced fractures.

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