Journal of Musculoskeletal Trauma

Bone Union Time of Simple Distal Femur Fractures in the Elderly according to Fracture Gap after Treated with Minimally Invasive Plate Osteosynthesis: Young Ho Cho, Sangwoo Kim, Jaewook Koo; J Korean Fract Soc 2023;36(4):133-138. Published online October 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.4.133

Abstract PDF: Purpose
This study examined the difference in bone union time according to the fracture gap after minimally invasive plate osteosynthesis (MIPO) for simple distal femoral fractures in elderly patients.
Materials and Methods
From January 2010 to December 2019, patients aged 60 years or older who underwent surgical treatment for distal femoral fractures due to a low-energy injury were investigated retrospectively. Forty patients were enrolled in the study. The patients were divided into two groups according to the fracture gap after reduction: no more than 2 mm (Group A) and more than 2 mm (Group B) in the anteroposterior and lateral plane. The demographic, operation time, presence or absence of cerclage wiring, plate screw density, plate span ratio, plate length, bone union period, non-union, and complications were evaluated.
Results
No statistical differences in operation time, cerclage wiring, plate screw density, plate span ratio, and plate length were observed between the two groups, and the bone union was achieved in all patients without complication. The bone union period was 17.24±1.48 weeks in Group A and 24.53± 5.20 weeks in Group B, which was statistically significant (p<0.001).
Conclusion
The bone union time in treating geriatric simple distal femur fractures using the MIPO tech-nique was significantly shorter in the 2 mm or less fracture gap than in the greater than 2 mm group.

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Usefulness of Reduction and Internal Fixation Using a 2.4 mm Hand Plating System in Type AO 33-A3 Distal Femur Fracture - Technical Note -: Bong-Ju Lee, Ja-Yeong Yoon, Seungha Woo; J Korean Fract Soc 2023;36(1):25-28. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.25

Abstract PDF: Open reduction in an AO 33-A3 class distal femur transverse and comminuted fracture is often difficult due to frequent reduction loss during surgery, leading to longer operative time and increased blood loss intra-operation. In this study, the authors report a case in which the use of an offset grid plate (OsteoMed, USA) using 2.4 mm HPS (hand plating system) eased the process of fracture reduction and achieved a stable internal fixation, ultimately leading to successful osteosynthesis. The authors experienced no need for temporary fixation devices such as K-wires or screws, which are otherwise required to stabilize the reduction. The fracture reduction was stable throughout the primary fixation of the fracture using a locking plate and screws. The authors report that the advantage of the HPS plate is fitting into the cortical contour and providing stable maintenance of fracture reduction intra-operation, which would be beneficial in certain distal femoral fracture patterns.

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Distal Femur Fractures Treated with Distal Femoral Locking Plate Fixation: A Retrospective Study of One Year Mortality and Risk Factors: Kwang-Hwan Jung, Yoon-Seok Youm, Seung-Hyun Jung, Jae-Min Oh, Ki Bong Park; J Korean Fract Soc 2023;36(1):10-16. Published online January 31, 2023; DOI: https://doi.org/10.12671/jkfs.2023.36.1.10

Abstract PDF: Purpose
This study examined the one-year mortality after locking plate fixation for distal femur fractures and the risk factors related to death.
Materials and Methods
From July 2011 to June 2020, 128 patients who underwent locking plate fixation for distal femur fractures were analyzed retrospectively. Epidemiologic information of the patients, characteristics related to fracture and surgery, and death were investigated. The risk factors related to death were investigated using Cox analysis, and a subgroup analysis was also performed based on the age of 65 years.
Results
The one-year mortality rate after locking plate fixation for distal femur fractures was 3.9%, and the mortality rates in patients younger than 65 years and older than 65 years were 0% and 6.7%, respectively. There were no significant risk factors related to death in the total population. On the other hand, in patients aged 65 years or older, however, high-energy fracture and high comorbidity index increased the risk of death after surgery by 6.9-fold and 1.9-fold, respectively.
Conclusion
The one-year mortality rate for the total patients was 3.9%, but the mortality rate for patients over 65 years of age increased to 6.7%. High-energy fractures and high comorbidity index were risk factors related to death after surgery for distal femur fractures in patients aged 65 years or older.

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Outcomes following Treatment of Geriatric Distal Femur Fractures with Analyzing Risk Factors for the Nonunion: Soo young Jeong, Jae Ho Lee, Ki Chul Park; J Korean Fract Soc 2019;32(4):188-195. Published online October 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.4.188; Correction in: J Musculoskelet Trauma 2020;33(1):62

Abstract PDF

PURPOSE
Many international journals have published studies on the results of distal femoral fractures in elderly people, but only a few studies have been conducted on the Korean population. The aim of this study was to determine the factors that are associated with the outcomes and prognosis of fixation of distal femur fractures using the minimally invasive plate osteosynthesis (MIPO) technique in elderly patients (ageâ‰¥60) and to determine the risk factors related witht he occurrence of nonunion.
MATERIALS AND METHODS
This study is a retrospective study. From January 2008 to June 2018, distal femur fracture (AO/OTA 33) patients who underwent surgical treatment (MIPO) were analyzed. A total of 52 patients were included in the study after removing 121 patients that met with the exclusion criteria. Medical records, including surgical records, were reviewed to evaluate the patients' underlying disease, bone mineral density, the number of days delayed from surgery, complications and mortality. In addition, follow-up radiographs were used to determine bone union, delayed union and nonunion.
RESULTS
The average time to achieve bone union was 19.95 weeks, the rate of nonunion was 20.0% (10/50) and the overall mortality was 3.8% (2/52). There were no significant differences in the clinical and radiological results of those patients with or without periprosthetic fracture. On the univariate analysis, which compared the union group vs. the nonunion group, no factors were identified as significant risk factors for nonunion. On the multiple logistic regression analysis, medical history of cancer was identified as a significant risk factor for nonunion (p=0.045).
CONCLUSION
The rate of nonunion is high in the Korean population of elderly people suffering from distal femur fracture, but the mortality rate appears to be low. A medical history of cancer is a significant risk factor for nonunion. Further prospective studies are required to determine other associated factors.

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Comparison of Clinical Outcomes for Femoral Neck System and Cannulated Compression Screws in the Treatment of Femoral Neck Fracture
Jae Kwang Hwang, KiWon Lee, Dong-Kyo Seo, Joo-Yul Bae, Myeong-Geun Song, Hansuk Choi
Journal of the Korean Fracture Society.2023; 36(3): 77. CrossRef

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Locked Plating in Elderly Patients with Distal Femur Fracture: How to Avoid Complications?: Chul Young Jang, Je Hyun Yoo; J Korean Fract Soc 2019;32(2):112-119. Published online April 30, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.2.112

Abstract PDF: Distal femur fractures in elderly patients with osteoporosis are complicated because poor bone quality makes screw purchase and fixation less secure, presenting many clinical challenges to the orthopedic surgeon. Minimally invasive locked plating using an angularly stable locking compression plate has become an integral tool for achieving secure fixation in osteoporotic distal femur fractures with improved biomechanical performance. On the other hand, complications, such as implant failure and periplate fracture, have still occurred. This paper describes the principles of internal fixation in minimally invasive lateral locked plating in elderly patients with osteoporotic distal femur fractures as well as how to avoid complications.

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Results after Less Invasive Locking Plating in Intra-Articular Fractures of the Distal Femur: Sung Hyun Kim, Sung Hyun Yoon, Hee Gon Park, Jae Uk Jung; J Korean Fract Soc 2019;32(1):14-20. Published online January 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.1.14

Abstract PDF: PURPOSE
The purpose of this study was to determine the clinical outcomes after a less invasive locking plating technique in intra-articular fractures of the distal femur.
MATERIALS AND METHODS
This was a retrospective 19 case series of patients with distal femoral intraarticular fractures treated with a less invasive locking plating technique in a single center (Dankook University Hospital) from June 2010 to April 2016. Nineteen patients (11 males and 8 females) with a mean age of 55.9 years were enrolled. The functional outcomes were evaluated using the visual analogue scale (VAS), range of knee joint motion (flexion & extension), and Knee Society score. The radiology outcomes were evaluated with parameters measured in a plain radiograph (deviation angle of alignment axis on coronal and sagittal plane, mechanical lateral distal femur angle).
RESULTS
The mean follow-up period was 26.4 months (range, 12â€“72 months) and the mean duration to union was 15.94 weeks (range, 11â€“28 weeks). The mean VAS was 1.36 (range, 0â€“8) and the range of motion of the knee joint was extension 4.73Â° (range, 0Â°â€“30Â°) and flexion 107.36Â° (range, 60Â°â€“135Â°). The mean Knee Society score was 85.47 (range, 47â€“100). The mean deviation angle of the coronal alignment axis was 4.07Â° (range, 1.3Â°â€“8.8Â°), the mean deviation angle of the sagittal alignment axis was 3.23Â° (range, 0.7Â°â€“7.0Â°), and the mechanical lateral femoral angle was 87.75Â° (range, 82.8Â°â€“95.5Â°). Six patients had traumatic osteoarthritis at the final follow-up.
CONCLUSION
The purpose of this study was to evaluate the clinical and radiologic outcomes of intraarticular fractures of the distal femur in patients who underwent an anatomical reduction through an open reduction, and converted to an extra-articular fracture with rigid internal fixation. The results were relatively satisfactory.

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Factors Affecting Posterior Angulation in Retrograde Intramedullary Nailing for Distal Femoral Fractures: Hohyoung Lee, Ji Ho Jeong, Min Su Kim, Bum Soo Kim; J Korean Fract Soc 2018;31(2):50-56. Published online April 30, 2018; DOI: https://doi.org/10.12671/jkfs.2018.31.2.50

Abstract PDF: PURPOSE
To analyze the factors that cause a posterior angulatory deformity in the retrograde intramedullary nailing of distal femoral fractures.
MATERIALS AND METHODS
Fifty-five patients with distal femur fractures who were treated with retrograde intramedullary nailing were enrolled in this study. They were followed-up for at least one year postoperatively. The posterior angulatory deformity was evaluated according to the fracture location, pattern, and insertion point and the insertion point was compared with the ideal point derived from the radiographs of 100 normal adults. The correlation between the posterior angulation and the entry point of the nail was analyzed.
RESULTS
The posterior angulation was similar in terms of the fracture location; a meaningful difference was noted among the fracture patterns (p=0.047). The posterior angulation was significantly greater when the entry point was located more posteriorly, accepting a malreduced state (p=0.012).
CONCLUSION
Posterior angulation was smaller in the transverse fracture and the posterior location of the entry point from the apex of the Blumensaat's line increased the posterior angulation.

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The Mid-Term Result after Osteosynthesis of Intra-Articular Fractures of Distal Femur: Sam Guk Park, Jeong Jae Moon, Oog Jin Shon; J Korean Fract Soc 2016;29(4):242-249. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.242

Abstract PDF

PURPOSE
This study was to evaluate the radiological and clinical mid-term results and the presence of post-traumatic osteoarthritis after osteosynthesis in patients under the age of 50 years undergoing osteosynthesis for distal femur intra-articular fractures (AO/OTA 33-B & C) from high-energy trauma.
MATERIALS AND METHODS
Between January 2008 and January 2013, a total of twenty-one patients with more than three years of follow-up were enrolled. Recovery of the alignment of the lower extremity, union period, and the presence of post-traumatic osteoarthritis were confirmed by follow-up radiographs. Clinically, the range of motion, pain on fracture lesion, and Knee Society score (KSS) were evaluated.
RESULTS
The average duration of union was 18.2 weeks (10-28 weeks), and the alignment of the lower extremity was within normal range in all patients. Seven patients showed post-traumatic osteoarthritis at the final follow-up after more than three years. The presence of post-traumatic osteoarthritis was associated with the classification of fractures, coronal plane fracture, and age. The average range of motion, knee score among KSS, and function score at the last follow-up were 128.7Â°, 86.1, and 85.1, all showing a greater improvement when compared with the one-year follow-up scores.
CONCLUSION
The mid-term result was radiologically and clinically satisfactory. Furthermore, only 33.3% of patients showed a slight progress of post-traumatic osteoarthritis, which critically effects the prognosis.

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Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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Medial Plating of Distal Femoral Fracture with Locking Compression Plate-Proximal Lateral Tibia: Cases' Report: Se Ang Jang, Young Soo Byun, In Ho Han, Dongju Shin; J Korean Fract Soc 2016;29(3):206-212. Published online July 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.3.206

Abstract PDF

Generally, lateral plating is used for a comminuted fracture of the distal femur. However, in some cases, it has been shown that using a medial plate is necessary to achieve better outcome. Nevertheless, there are no available anatomical plates that fit either the distal medial femoral condyle or fracture fixation, except for the relatively short plate developed for distal femoral osteotomy. We found that locking compression plate-proximal lateral tibia (LCP-PLT) fits anatomically well for the contour of the ipsilateral medial femoral condyle. Moreover, LCP-PLT has less risk of breaking the thread holes since it rarely needs to be bent. We report a plastic bone model study and two cases of distal femoral fractures fixed with medial plating using LCP-PLT.

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A novel anatomical locked medial femoral condyle plate: a biomechanical study
M. A. Ozer, S. Keser, D. Barıs, O. Yazoglu
European Journal of Orthopaedic Surgery & Traumatology.2024; 34(5): 2767. CrossRef
Medial plating of distal femur: which pre-contoured angular stable plate fits best?
Shaam Achudan, Rex Premchand Antony Xavier, Sze Ern Tan
European Journal of Orthopaedic Surgery & Traumatology.2024; 34(6): 3297. CrossRef
Medial augmentation of distal femur fractures using the contralateral distal femur locking plate: A technical note
Jaime Andrés Leal
OTA International.2024;[Epub] CrossRef
The missing piece of the trauma armoury-medial femoral condyle plate
Piyush Upadhyay, Farhan Syed, Darryl N Ramoutar, Jayne Ward
Injury.2022; 53(3): 1237. CrossRef
Surgical Tips and Tricks for Distal Femur Plating
Christopher Lee, Dane Brodke, Ajay Gurbani
Journal of the American Academy of Orthopaedic Surgeons.2021;[Epub] CrossRef
Medial minimally invasive helical plate osteosynthesis of the distal femur – a new technique
G.M. Hohenberger, A.M. Schwarz, P. Grechenig, B. Clement, Mario Staresinic, Bore Bakota
Injury.2021; 52: S27. CrossRef
Feature-Based Design of Personalized Anatomical Plates for the Treatment of Femoral Fractures
Xiaozhong Chen, Zhijian Mao, Xi Jiang
IEEE Access.2021; 9: 43824. CrossRef

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Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture: Sung Won Cho, Sang Ho Ha, Gwang Chul Lee, Woong Hee Kim; J Korean Fract Soc 2013;26(3):205-211. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.205

Abstract PDF

PURPOSE
To analyze the clinical and radiologic results of minimally invasive plate osteosynthesis (MIPO) for distal femur fractures using a locking compression plate (LCP) and to evaluate its usefulness.
MATERIALS AND METHODS
From May 2006 to April 2011, 23 patients (24 cases) with distal femur fracture were treated by MIPO with a LCP and followed-up for at least 12 months. Mean age was 61.6 years (35-80 years). Union time and post-operative alignment were measured on radiograph, and clinical function was evaluated by range of motion (ROM), Knee Society Score and complications.
RESULTS
In 22 patients (23 cases) except for 1 case, bony union was obtained after an average of 18 weeks (12-26 weeks). The mean ROM was 124 degrees (80-135 degrees). According to the Knee Society Score, there were 12 excellent, 8 good, 1 fair and 2 poor results and the mean score was 87.5 (60-98). Postoperative complications were nonunion in 1 case, ankylosis in 1 case, malunion in 2 cases and superficial wound infection in 2 cases.
CONCLUSION
The treatment of distal femoral fracture with MIPO using a LCP was considered a useful method which can result in satisfactory clinical and radiologic outcomes if there is accurate understanding about the surgical techniques and appropriate procedures involved.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef

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Treatment of Distal Femur Fracture with Minimally Invasive Locking Compression Plate Osteosynthesis: Ki Chul Park, Kyu Sung Chung, Joon Ki Moon; J Korean Fract Soc 2012;25(1):13-19. Published online January 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.1.13

Abstract PDF

PURPOSE
To analyze the result of distal femur fracture treatment with minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP).
MATERIALS AND METHODS
From December 2004 to April 2010, 33 patients with distal femur fractures were treated by MIPO with a locking compression plate. The reduction state and bone union time was checked radiologically. The clinical outcome was evaluated by the Schatzker and Lambert criteria.
RESULTS
The mean bone union time was 16.3 weeks (10~22 weeks). There were 3 nonunions, 2 broken plates, 1 superficial infection, 7degrees of valgus angulation in 1 case, and 1.5 cm limb shortening in 1 case. Except for the 3 nonunion cases, according to the Schatzker and Lambert criteria, results were graded as excellent in 11 cases, good in 14 cases, and moderate in 5 cases.
CONCLUSION
The treatment of distal femoral fracture by MIPO with a locking compression plate resulted in good functional and radiological outcomes, but it has problems, such as broken plates and nonunion. Accurate surgical technique and appropriate treatment will be needed according to fracture type.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Comparing Outcomes of Retrograde Intramedullary Nail and Locking Plate Fixation in Distal Femoral Fractures
Byung-Ho Yoon, Bo Kwon Hwang, Hyoung-Keun Oh, Suk Kyu Choo, Jong Min Sohn, Yerl-Bo Sung
Journal of the Korean Fracture Society.2021; 34(4): 131. CrossRef
Incidence of nonunion after surgery of distal femoral fractures using contemporary fixation device: a meta‐analysis
Byung-Ho Yoon, In Keun Park, Youngwoo Kim, Hyoung-Keun Oh, Suk Kyu Choo, Yerl-Bo Sung
Archives of Orthopaedic and Trauma Surgery.2021; 141(2): 225. CrossRef
Minimally Invasive Plate Osteosynthesis with Locking Compression Plate for Distal Femur Fracture
Sung Won Cho, Sang Ho Ha, Gwang Chul Lee, Woong Hee Kim
Journal of the Korean Fracture Society.2013; 26(3): 205. CrossRef

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The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach: Sung Sik Ha, Jae Chun Sim, Ki Do Hong, Jae Young Kim, Kwang Hee Park, Yoon Ho Choi; J Korean Fract Soc 2009;22(4):246-251. Published online October 31, 2009; DOI: https://doi.org/10.12671/jkfs.2009.22.4.246

Abstract PDF

PURPOSE
To evaluate clinical and radiological results of surgical treatment of distal femur medial condyle fracture using lateral anatomical plate of opposite side through medial approach. MATERIALS AND METHODS: This study reviewed the results of 9 cases of distal femur medial condyle fracture treated with lateral anatomical plate of opposite side through medial approach from December 2005 to June 2007, after a follow up of more than 12 months. There were 2 males and 7 females with a mean age of 63.1 (57~72) years. The clinical results were evaluated using the Schatzker's criteria, and the radiographic results were evaluated using the bone union time. RESULTS: Using the Schatzker's criteria, 7 cases of the 9 patients (78%) showed exellent results. The mean time for bone union was 13.4 (11~15) weeks. There were 3 cases of pain on full weight bearing same as previous operative state by degenerative osteoarthritis. There weren't complications as joint stiffness, infection, varus & rotational deformity, malunion, nonunion, and metal failure. CONCLUSION: Plate fixation using medial approach provides the proper anatomical reduction and stronger fixation, and outcome good results.

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Medial Plating of Distal Femoral Fracture with Locking Compression Plate-Proximal Lateral Tibia: Cases' Report
Se-Ang Jang, Young-Soo Byun, In-Ho Han, Dongju Shin
Journal of the Korean Fracture Society.2016; 29(3): 206. CrossRef

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Treatment of the Distal Femur Fracture with Retrograde Intramedullary Nailing: Moon Jib Yoo, Myung Ho Kim, Hee Gon Park, Woo Sup Byun, Ki Choul Kim; J Korean Fract Soc 2005;18(3):238-243. Published online July 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.3.238

Abstract PDF

PURPOSE
To evaluate the results and complications of the retrograde intramedullary nailing for the treatment of distal femur fracture.
MATERIALS AND METHODS
Thirty three patients who received retrograde IM nailing for fractures of the distal femur between October 1998 to December 2003. Average age was 53.8+/-17 (17~86) years. The average follow up period was 19.4 (12~36) months. Clinical information included age, sex distribution, associated fracture and fracture was classified by AO classification. Functional result was evaluated by Schatzker's criteria.
RESULTS
The most common cause of injury was traffic accident (60%). The type of fracture were 6 A1 cases, 5 A2 cases, 11 A3 cases, 5 C2 cases, 6 C3 cases by AO classification. Among the 33 cases, 15 cases were excellent, 9 good, 6 fair and 1 failure according to Schatzker's criteria. Average union time was 9.7+/-3.5 months.
CONCLUSION
Treatment of distal femur fracture with retrograde intramedullary nailing was useful due to its minimal invasiveness and early range of motion, more rigid fixation.

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Retrograde Intramedullary Nailing for Periprosthetic Supracondylar Fractures of the Femur after Total Knee Arthroplasty
Hyuk-Soo Han, Kyu-Won Oh, Seung-Baik Kang
Clinics in Orthopedic Surgery.2009; 1(4): 201. CrossRef
Retrograde Nailing for Supracondylar Fracture after Total Knee Replacement: The Compatibility of Femoral Implant with Supracondylar Nail
Moon-Jib Yoo, You-Jin Kim, Jin-Won Lee
Journal of the Korean Fracture Society.2008; 21(1): 19. CrossRef
Midterm Results of Treatment with a Retrograde Nail for Periprosthetic Fractures of the Femur Following Total Knee Arthroplasty
Kyung-Taek Kim, Jin-Hun Kang, Lih Wang, Jae-Sung Hwang
Journal of the Korean Fracture Society.2007; 20(4): 309. CrossRef

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Treatment of Distal Femoral Shaft and Supracondylar Fracture with aRetrograde Intramedullary Nailing: Sang Hong Lee, Jun Young Lee, Sang Ho Ha, Hong Moon Sohn, Kwang Chul Lee; J Korean Fract Soc 2004;17(2):103-109. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.103

Abstract PDF

PURPOSE
Retrograde intramedullary nailing has been recommended as one of the treatment options for the distal femoral fracture, particularly in patients who are obese, are pregnant, has sustained ipsilateral femoral neck fracture, have multiple injuries. However there are some disadvantage such as post-arthrotomy infection, knee joint stiffness. This paper is to evaluate the result and complication of treatment of distal femoral fracture with a retrograde intramedullary nailing.
MATERIALS AND METHODS
We reviewed 13 cases (distal femoral shaft fracture: 6 cases, supracondylar fracture: 7 cases) of the distal femoral fracture who had been treated with retrograde intramedullary nailing and follow up for more than 12 months from January 1999 to December 2001. The rate of bony union, range of motion of the knee, complications were evaluated.
RESULTS
The mean duration of bony union was 20 weeks (range, 16~25 weeks). A case of delayed union was developed. In 4 cases of 13 cases showed posterior angulation below 6 degree, which did not need further treatment. According to Saunder's criteria, excellent result was achieved in 8 patients, good result in 5 patients, respectively.
CONCLUSION
This study showed good clinical and radiological results of union with retrograde intramedullary nailing at the distal femoral fracture and ipsilateral multiple fracture

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Analysis of Risk Factors for Nonunion after Intramedullary Nailing of Femoral Shaft Fracture in Adult
Yong-Woon Shin, Yerl-Bo Sung, Jeong Yoon Choi, Minkyu Kim
Journal of the Korean Fracture Society.2011; 24(4): 313. CrossRef
Axial Malalignment after Minimally Invasive Plate Osteosynthesis in Distal Femur Fractures with Metaphyseal Comminution
Jae-Ho Jang, Gu-Hee Jung, Jae-Do Kim, Cheung-Kue Kim
Journal of the Korean Orthopaedic Association.2011; 46(4): 326. CrossRef

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Comparision of Operative Treatment Methods of AO type C2-C3 Fractures of the Distal Femur: Beom Koo Lee, In Ho Seong, Min Ho Song; J Korean Soc Fract 2000;13(4):861-867. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.861

Abstract PDF: PURPOSE
To evaluate the advantages of transarticular reconstruction and fixation of metaphysis by MIPO technique for AO type C2-C3 fractures of the distal femur. MATERIAL AND METHODS: In a retrospective study conducted from January 1996 to December 1997, AO type C2-C3 fractures of the distal femur were treated using three techniques; 1) A group-MIPO technique and medial parapatellar arthrotomy for the direct reduction of the condylar block(10 cases), 2) B group-conventional AO technique(8 cases) 3) C group-closed supracondylar nailing(4 cases). Minimal followup time was 12 months.
RESULTS
Time to bone healing was 15 weeks in A group, 20 weeks in B group, and 16 weeks in C group. complication rate was 0% in A group, 50% in B group, and 50% in C group. normal alignment between 0 & valgus 9 degrees was 100% in A group, 75% in B group, and 50% in C group. Neer score was 90% excellent or satisfactory in A group, 75% in B group, and 50% in C group respectively. The results of A group was better than those of B and C group.
CONCLUSION
Transarticular joint reconstruction and MIPO technique for AO type C2-C3 fractures of the distal femur is an excellent technique to obtain more rapid bony union with less complications.

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Anatomical Plate Fixation for Distal Femur Fracture: Eun Sun Moon, Keun Bae Lee, Jong Wook Jeong; J Korean Soc Fract 1999;12(2):294-300. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.294

Abstract PDF

The fractures of the distal femur which involve supracondylar or intercondylar region are difficult to manage because occasionally, severe soft tissue damage, comminution, intra-articular extension of fracture and injury to the quadriceps mechanism lead to unsatisfactory results in many case. Recently, early anatomical reduction, rigid internal fixation and early exercise of the knee joint has been recommended. A clinical and radiological analysis was performed on 48 cases with fractures of distal femur who had been treated by anatomical plate and followed for minimum 1 year from April 1990 to July 1997. According to AO classification, 22 cases(45.8%) were type A, 1 case(2.1%) were type B and 25 cases(52.1%) were type C. The functional results by Sanders-Swiontkowski-Rosen-Helfet rating system were showed excellent in 15(31.3%), good in 17(35.4%), fair in 13(27.0%) and poor in 3 cases(6.3%). The overall results were seen to be excellent or to be good in 32 cases(66.7%) and results were worse in type C, old age, open fractures. The most common complication was limited range of motion of the knee under 90 degrees in 10 cases, including nonunion caused by loosening of screw in 1 case, metal failure in 1 case and shortening in 1 case. And other complications were delayed union in 4 cases and angular deformity in 2 cases. In conclusion, ideal indication for anatomical plating may be a metaphyseal fracture of distal femur with or without involvement of articular surface in young adult. Anatomical plate may be alternative one among the fixation devices for distal femur fractures.

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Surgical Treatment of AO/OTA 33-C Intra-Articular Distal Femoral Fractures through Parapatellar Approach
Suk Kyu Choo, Sung Tan Cho, Hyoung Keun Oh
Journal of the Korean Fracture Society.2022; 35(1): 1. CrossRef
Treatment of Femur Supracondylar Fracture with Locking Compression Plate
Seong Ho Bae, Seung Han Cha, Jeung Tak Suh
Journal of the Korean Fracture Society.2010; 23(3): 282. CrossRef
The Surgical Treatment of Distal Femur Medial Condyle Fracture Using Lateral Anatomical Plate of Opposite Side through Medial Approach
Sung-Sik Ha, Jae-Chun Sim, Ki-Do Hong, Jae-Young Kim, Kwang-Hee Park, Yoon-Ho Choi
Journal of the Korean Fracture Society.2009; 22(4): 246. CrossRef

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Treatment of Comminuted Supracondylar and Intercondylar Femoral Fractures with AO Dynamic Condylar Screw: Kyung Chul Kim, Jae Yeul Choi, Hwa jae Jeong, Bon Seep Koo, Kyung Ho Kim; J Korean Soc Fract 1999;12(2):253-258. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.253

Abstract PDF: Between 1990 and 1995, 22 comminuted supracondylar and intercondylar femoral fractures in 22 patients were treated with the AO dynamic condylar screw(DCS). Minimum twelve months of clinical and radiographic follow-up evaluation were available on all patients. All cases achieved clinical and radiographic bony union. Functional results were graded using a Schatzker and Lambert's criteria. Results were seen to be excellent to good to fair in 100% of A2 cases, 86% of C2 cases, 75% of A3 cases and 67% of C3 cases. The more comminuted fractures were found to have worse clinical results and more radiographic malunion. The ability to obtain good fixation in osteoporotic bone is distinct advantage of the DCS. The results of DCS fixation compare favorably with previous studies using other fixation devices in comminuted supracondylar and intercondylar femoral fractures

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A Clinical Analysis of Distal Fracture of the Femur with DCS Fixation & Early Exercise: Soo Jae Yim, Dong Jin Kim, Seung Ryul Yoon; J Korean Soc Fract 1998;11(3):514-521. Published online July 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.3.514

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Fracture of the distal femur is not as common as femoral shaft or hip fracture. A widening medullary canal, thin cortex, osteopenia make open reduction and internal fixation difficult, enen for an experienced surgeon, The surgical treatment for supracondylar femoral fractures has a better outcome becuse of improved implants, fixation technique and preoperative planing during the past two decades. We reviewed 33 cases of fractures of the distal femur at Soon Chun Hyang Gumi Hospital from June, 1992 to March, 1996 with minimum 12 months follow up. Following results were obtained. 1. In age distribution, fourth decade was most frequent. 2. The most common cause of these fractures was traffic accident. 3. The most common fracture type was type C by Muller classification. 4. Complication were as follows : pain, knee joint stiffness, bursitis, skin infection etc 5. The satisfactory results could be obtained by the open reduction and rigid internal fixation followed by early R.O.M. exercise of knee joint.

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Bone Union Time of Simple Distal Femur Fractures in the Elderly according to Fracture Gap after Treated with Minimally Invasive Plate Osteosynthesis
Young Ho Cho, Sangwoo Kim, Jaewook Koo
Journal of the Korean Fracture Society.2023; 36(4): 133. CrossRef

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Fatigue Fracture of the Distal femur Shaft: A Case Report: Seung Gyun Cha, Kyoung Hoon Kim, Jong Ho Jang, Sang Jun Lee; J Korean Soc Fract 1997;10(4):979-982. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.979

Abstract PDF: A fatigue(stress) fracture begins as a gradual localized dissolution of bone as a result of repeated submaximal and generally unaccustomed stresses which may or may not result in a complete fracture. The most common sites of fatigue fracture are tibia, metatarsal area. We experienced peculiar faligue fracture in professional bowler. So we review the fatigue fracture article and reporte 1 case of fracture in distal part of femur with clinical and radiological findings.

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Double-Plating in the Comminuted Supracondylar Fracture of the Distal Femur: Taek Rim Yoon, Sung Taek Jung, Hyoung Yeon Seo; J Korean Soc Fract 1997;10(4):778-784. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.778

Abstract PDF: Supracondylar fracture of femur is not well suited to internal fixation. A wide canal, a thin cortex, comminution and compound wound make open reduction more difficult. Especially, type C2 and C3 on AO classification is problematic. The cases of nine patients who had type C2 or C3 fracture including three open fractures and deficient medial-cortical buttress were reviewed. Stable fixation was achieved with the lateral condylar buttress plate. Additional stabilization with a medial plate and bone graft from the iliac crest was applied in all nine patients. At an average duration of follow-up nineteen months(range from twelve to forty-eight months), all of the fracture had healed. Evaluation of the functional outcome revealed two excellent, three good and four fair results. In three patient, less than 90 degree of flexion of the knee was present and in six, the arc of flexion was limited to between 90 and 110 degrees. One patient had two centimeter shortening, one had medial screw loosening which need not additional fixation. The results of our study suggest that, for the treatment of patients who have a difficult fracture in whom stable fixation of the distal part of the femur cannot be achieved with a condylar buttress plate because of medial cortical communition, a short distal condylar fragment, or loss of metaphyseal bone, double-plating is indicated.

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Fatigue Fracture of the Distal Femur in Adolescence: A case Report: Nam Hong Choi, Young Sun Song, Ho Min Lee; J Korean Soc Fract 1996;9(3):809-813. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.809

Abstract PDF: Fatigue fractures have been described in almost every bone in the body, but they are more common in the bones of the lower extremities. Fatigue fractures are seen mainly in military personnel especially at basic training center, athletes, ballet dancers, laborers, and even pregnant woman. But they rarely developed at the distal femur of adolescent. We report a case of fatigue fracture of the distal femur in adolescent who was associated with neithor trauma nor sports activity.

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Clinical Result of Surgical Treatment in Distal Femur Fractures using Dynamic Compression Screw and Blade Plate: Seung Baik Kang, Joong Hee Won, Bong Soon Chang, Eui Seong Choi, Jin Seon Yoo, Hee Joong Kim; J Korean Soc Fract 1996;9(3):557-566. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.557

Abstract PDF: The fracture of distal femur, which include the supracondylar region, intercondylar region and knee joint, have many problems by nature. It is almost all comminuted fracture and has a some difficulty in approach. Early attempts at internal fixation frequently gave unacceptably high rates of malunion, nonunion, and infection. Traditionally, nonsurgical treatment has been favored. Over the past 15 years, improved and meticulous techniques of internal fixation has been shown to yield good to excellent results. Also a number of excellent devices are now available. We reviewed the patients who were admitted for fractures of the distal femur and were treated by the surgical treatments at department of Orthopaedic Surgery, Chungbuk National University Hospital from July 1993 through Augrst 1994. Fourteen cases were followed for more than one year. An average age at operation was 54 years (range, 18-74 years). The analysis group consisted of 9 males and 5 females. The cause of injuries were motor cycle injury in 8 cases, in-car accident in 2 cases, pedestrian injury in 2 cases and fall down in 2 cases. According to the classifications of AO, 4 cases were type Al, 2 were type A2, 2 were type A3, Cl was 1 case, C2 were 2 cases and C3 were 3 cases. Open fractures were 2 cases. Blade plate was used in 10 cases and DCS(dynamic compression screw) in 4 cases. With serial follow-up X-ray, ROM of knee and Neers scoring system, evaluation was performed. Excellent or good results were obtained in 13 cases (93%). Deep infection was developed in one case. At last follow-up, ROM was satisfactory. Blad plate was very useful for severe osteoporotic patient. For comminuted, displaced intra-articular fractures such as Type C, extensile surgical approach was most useful.

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Result of 29 consecutive patients with the distal femiral fracture: Analysis of the result treated with AO DCS(dynamic condylar Screw) Supracondylar nail, May anatomical plate: Weon Yoo Kim, Jin Hyung Sung, Chong Hoon Park, Jeong Soo Park, Jin Yong Kim; J Korean Soc Fract 1996;9(1):68-75. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.68

Abstract PDF: Twenty-nine cases of the surgically treated distal femoral fracture were analyzed to compare internal fixatorw (AO DCS,Supracondylar nail, May anatomical plate),who were treated at Department of orthopaedic surgery, Taejon Saint Marys hospital from Jan. 1992 to Jun. 1994. The cases were classified according to AO classification and minmum 12 months(average:22.4 monthw) follow up. Following results were obtained: 1.Male was more common than female, age distrbution was between 16 and 77 years old(average 40.4), abd the most common cause of the fracture was traffic accident. 2.The most comon type C by AO classification(type A 11 cases, type B 1 case, type C 17 cases). 3.According to Schatzkers criteria in the clincal result, type A,B were better resykt than type C, and severe soft tissue damage, comminution and joint involvement lead to unsatisfactory results. 4.Supracondylar nail was inadequate implant due to inferior clinical result(1 excellent, 2 good and 3 poor). 5.DCS had more sateafactory result than other internal fixators(supracondylar nail, May anatomical plate). Based on the observations, the better results depend on the amount of initial trauma, early anatomical reduction, rigid internal fixation and exercise of the knee joint.

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Operative Treatment of the fractures of the Distal Femur: Jeung Tak Suh, seung Wook Kim, Chong Il Yoo; J Korean Soc Fract 1996;9(1):59-67. Published online January 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.1.59

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Fractures of the distal femur which include supracondylar and intercondylar injuries are difficult to manage. Usually combined with high energy trauma, there are severe soft tissue damage, comminu tion, intra-articular fracture, and injury to the quadriceps mechanism lead to unsatisfactory results in many cases, regardless of the treatment. The goals of treatment are to achieve fracture union and to restore early knee motion. Before 1960, preferred method of menagment was primarily traction alone or combination with a cast. During the last two decades, as technology and implants have been improved, most traumatologists have advocated some form of internal fixation in the managment of distal femur fractures. Surfaces, restorative treatment requires achieving the following goals;anatomic reduction of joint surfaces, restoration of limb length and alignment, rigid fixation, and eatly knee range of motion. Author reviewed and clinically analysed 42 cases of the fractures which were followed more than one year at the orthoedic department of Pusan National Universty Hospital during the period from January 1987 to December 1993. The results were as follows; 1.The incidence was higher in active young age group. 2.The most common cause of the injury was traffic accident with high energy rauma(59.5%) and the most frequent injury type by Mullwes classification was C type(59.5%) 3.Overall result estimsted by schatzkers criteria was excellent in 10 cases(28.6%), good in 4 cases(40.0%), faur in 6 cases(17.1%) and poor in 5 cases(14.3%). 4.The causes of poor resulted cases were open fractures, fracture with articular comminution and inadequate anatomical reduction. 5.Rigid internal fixation permits early functional rehabilitation of the patient and decrease the incidence of malunion, nonunion and loss of fixation.

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Fractures of the distal femur in elderly patients: retrospective analysis of a case series treated with single or double plate
Dae Jin Nam, Min Seok Kim, Tae Ho Kim, Min Woo Kim, Suc Hyun Kweon
Journal of Orthopaedic Surgery and Research.2022;[Epub] CrossRef

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Operative Treatment with Plate Screw Devices for Distal Femoral Fracture: Hak Yeong Jeong, Seung Wook Yang, Young Cheol Shin, Han Sung Park; J Korean Soc Fract 1994;7(2):512-521. Published online November 30, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.2.512

Abstract PDF: Until 1960, conservative managemant was considered superior to operative treatment of distal femoral fracture. But with advancement of new fixation divices and techniques, open reduction and internal fixation is recent trend. From May, 1986, to May, 1993, at Pusan Maryknoll hospital, the results of 39 cases of distal femoral fracture treated operatively with plate screw devices were analyzed after minimum follow up of 1 year according to the rating system of Schatzker and lambert. The results were as follows: 1. Average radiologic union time was 16.3 weeks. 2. According to Schatzker and Lamberts criteria, excellent was 17 cases, good in 13 cases, fair in 5 cases and failure in 4 cases. 3. For fixation of distal femoral fracture with severe comminution at metaphyseal portion, the condylar blade plate and dynamic condylar screw showed better result than anatomical plate. 4. With extensile approach, the dynamic condylar screw showed excellent result for distal femoral fracture with intraarticular comminution. We concluded that wide exposure enough for accurate reduction of fracture fragments aud joint surface and rigid internal fixation were the cornerstone for treatment of the distal femoral fracture.

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The Treatment in Infected Nonunion of Distal Femoral Fracture: Report of two cases: Jong Oh Kim, Yon Sik Yoo, Suk Ha Lee, Sung Jong Lee, Taek Sun Kim, Jae Ik Sim; J Korean Soc Fract 1994;7(1):161-166. Published online May 31, 1994; DOI: https://doi.org/10.12671/jksf.1994.7.1.161

Abstract PDF: It is reported that infected pathological fracture of distal femur has a difficulty in treatment The difficulties lie in; choosing a internal fixator, adequate sequestrectomy of infected lesion, limb shortening, long duration of immobilizatlon. We uses the external fixator in treatment of distal femoral fracture because it needs less devices in fracture site than the internal fixator, and it could get a rigid fixation. we uses the Ilizarov apparatus. The merits of Ilizarov are, early weight bearing; limb lengthening and easy compression and distraction. The one case in which limb length discrepancy is occured, is peformed by limb lengthening. In this study, we are going to argue about the two cases, of infected non-unlon of distal femoral fixation comparing with one another.

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