Your knees make most of your daily activities possible. You use them to get out of bed, walk to the sink to brush your teeth, and they carry you throughout the day as you get ready for work, take the kids to school, and perform other activities. But, as with most body parts, most people don’t stop to think about them — until pain or discomfort signals that there’s something wrong. That’s when you should see an experienced orthopedic specialist at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado right away. A distal femur fracture is a serious matter because of the number of blood vessels in the bone and the risk a break can pose to surrounding muscles. A misdiagnosis or delay of care can result in serious complications.
OVERVIEW
A distal femur fracture is a break of the thigh bone just above the knee. The distal femur can be broken into many pieces or just crack slightly depending on the quality of the bone and type of injury. The cracks from a distal femur fracture can extend into the knee joint itself. Fractures of the distal femur most commonly occur in two patient types: younger people (under age 50) who have high-energy injuries and the elderly with weak bones that can result in a fall. Distal femur fractures account for 7% of all femur fractures. Other medical terms for a distal femur fracture are supracondylar femur fracture, intercondylar femur fracture, or Hoffa’s fracture. In both the young and the elderly the breaks that occur may shatter the bone into pieces.
ABOUT THE KNEE
The knee is the largest weight-bearing joint in the body. It helps one sit, stand, lift, walk, run, and jump. It also has many parts that can get injured: tendons, ligaments, cartilage, and bones that you can crack, tear, dislocate, and more. It’s one of the most stressed joints in the body. For every pound one weighs, the knees receive four times the amount of stress. This is why if one is overweight or obese, losing weight is essential to protecting knee health. The knees are the most complicated joints in the body. While to the naked eye, the knees may just look like a ball-shaped patella cradled between two larger bones, the joint is composed of the femur (thigh bone), patella (knee cap), and the top section of the tibia (the shin bone). All of it is held in place by tendons and ligaments — and in between all of it, there’s cartilage that allows the knee to glide smoothly. If this is disrupted, arthritis can occur.
WHAT IS A DISTAL FEMUR FRACTURE?
A distal femur fracture is a fracture found at the end of the thigh bone (the distal femur). Distal femur fractures can vary:
Closed fracture—the skin is not ruptured.
Open fracture—the skin is cut open during the injury and a part of the bone may stick out. They have a higher risk of complications and take a longer time to heal.
Comminuted fracture—the injury causes the bone to shatter into multiple pieces.
Transverse fracture—the crack or breakage occurs straight across the bone These fractures may not only damage the femur but also affect the tendons and ligaments that surround it. The hamstring and the quadriceps muscles may tend to snap and shorten when the bone breaks.
Intra-articular fractures—sometimes, these fractures extend into the knee joint and separate the surface of the bone into a few or many parts. These types of fractures are called intra-articular because they damage the cartilage surface of the bone. Intra-articular fractures can be more difficult to treat.
CAUSES
Distal femur fractures in younger patients are usually caused by high-energy injuries such as falls from significant heights or motor vehicle accidents. High-impact trauma, which is common in sports involving sudden stops, changes in direction, or collisions such as in soccer, basketball, and skiing can cause distal femur fractures. Elderly people with distal femur fractures typically have poor bone quality or osteoporosis. As people age, their bones get thinner. Bones can become weak and fragile. A lower-force event, such as falling from a standing position or falling out of bed, can cause a distal femur fracture.
SYMPTOMS
- Severe pain
- Swell and bruising
- Inability to stand or bear body weight
- The injured area may be tender when touched
- Deformity—the knee may look “out of place” and the leg may appear shorter and crooked
NON-SURGICAL TREATMENT
Small breaks or those with good overall alignment often can be treated without surgery. Non-surgical treatment options include:
Skeletal traction—skeletal traction is a pulley system of weights and counterweights that hold the broken pieces of bone together. A pin is placed in a bone to position the leg.
Casting and bracing—casts and braces hold the bones in place while they heal. In many cases of distal femur fracture, however, a cast or brace cannot correctly line up the bone pieces because shortened muscles pull the pieces out of place. Only fractures that are limited to two parts and are stable and well-aligned can be treated with a brace.
If non-operative care is chosen, regular follow-up care including physical exam and X-rays is important to ensure that the fracture stays in good position and heals properly. Patients with distal femoral fractures of all ages do best when they can be up and moving soon after treatment (such as moving from a bed to a chair and walking). Treatment that allows early motion of the knee lessens the risk of knee stiffness and prevents problems caused by extended bed rest, such as bed sores and blood clots.
WHEN IS SURGERY INDICATED?
Most often, a distal femur fracture requires surgery to guide the bones into place so that they can heal properly. Some types of surgery include:
Open Reduction and Internal Fixation (ORIF)
—Plates and Screws: metal plates and screws are used to hold bone fragments in place
—Intramedullary Nailing: a metal rod is inserted in the marrow canal of the femur to stabilize the fracture
Closed Reduction and External Fixation (ExFix)
—This involves placing pins or screws into the bone on both sides of the fracture, which are then connected to a metal frame outside the body. This is typically used in cases with severe soft tissue damage or when immediate Internal Fixation is not possible
Arthroplasty
—In severe cases where the fracture involves the joint surface significantly, or in older patients with pre-existing arthritis, a knee replacement may be an option
GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.
Procedures for distal femur fractures are often complicated and require precision to restore the overall alignment of both the femur and the joint surfaces. The first-class surgeons at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado, approach their patient’s conditions with meticulous skill. Physical examination is critical in the evaluation of these injuries. Important nerves and blood vessels run next to this bone and can be injured when it breaks. X-rays will likely be the first imaging test performed. These provide a clear image of bone and will allow the doctor to see whether the femur and surrounding joints are intact and stable. An angiography is performed when there is suspected damage to the blood vessels. A CAT scan is ordered when there is concern that the fracture has extended into a nearby joint. The immensely skilled surgeons at Advanced Orthopedics keep up with the latest, evolving developments in surgical techniques, and will explore every option to find the best therapeutic option that will return you to all the activities you want to do and all the everyday tasks you need to do.