ADVANCES IN THE SURGICAL TREATMENT OF DISTAL FEMORAL FRACTURES
Abstract:
In the last decade, the treatment of distal femoral fractures remains a challenge for the orthopedic surgeon, despite the evolution of surgical techniques and implants. The relative high incidence of intraoperative and postoperative complications has led to improved surgical techniques – surgical approaches, reduction techniques, as well as to more adapted, dedicated implants. These two directions have developed in parallel and are highly interdependent. The use of minimal invasive techniques has led to the development of adapted surgical implants in order to facilitate the submuscular insertion of the plate and the percutaneous insertion of locking screws - for plate osteosynthesis and intramedullary nails. On the other hand, the rapid evolution of technology allowed the fabrication of more resistant implants in general, or with equal resistance at smaller sizes, or with a particular distribution of holes for the locked screws/interlocking bolts without impairing the global strength of the implant. Consecutively, the reduction and temporary fixation techniques had to be improved. The evolution led to indirect, percutaneous reduction techniques. Last but not least, surgical techniques and implants had to adapt to the increasing number of patients with moderate to severe osteoporosis, with fragility fractures of the distal femur. These patients need minimal approaches, adapted reduction techniques and angular stable implants. In conclusion, the choice of an implant depends on: type of fracture, bone quality, but also on the availability, surgical technique difficulty and surgeon’s preference. Nowadays, the treatment of distal femoral fractures shows a continuous improvement, regarding the surgical techniques and the stabilization methods. This fact proofs that the ideal solution has not yet been found.
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