Compound Distal Femur Fracture Surgical Procedure

Surgery is recommended as the best course of action following a compound distal femur fracture in order to both stabilise the bone and joint and to minimise the risk of infection. 

Complex fractures require open reduction and internal fixation.

The internal fixation methods include:

  • Intramedullary nailing: This procedure involves a specially designed metal rod inserted into the marrow canal of the femur. The rod passes across the fracture to keep it in position while it heals.
  • Plates and screws: During this procedure, the bone fragments are first reduced (repositioned) into their normal alignment. They are then held together with specialty screws and metal plates which are attached to the outer surface of the bone.

Both of these methods can be performed using one large incision or several smaller ones depending on the type of fracture and its severity.

If the fracture has broken the bone into many small pieces above the knee joint, it is generally not pieced back together but rather a plate or rod will be fixed at both ends of the fracture without touching the multiple small pieces. This method keeps the overall shape and length of the bone in its natural form while it heals. As it heals the individual pieces will then grow into the new bone, which forms a callous.

In cases where the fracture may be slow to heal, such as when the patient is elderly with poor bone quality, a bone graft may be used to help facilitate the callous forming.  Bone grafts can be obtained from the patient themselves (usually taken from the pelvis) or cadaver bone taken from a tissue or bone bank. Alternatively artificial bone fillers can be used.

In extreme cases where the fracture is too complicated and the bone quality too poor to fix, the fragments are removed ant the bone is replaced with a knee replacement implant.

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