M.E.Müller: Atlas: Fracture 33-C2

Femur, Distal, complete
articular fracture, articular simple,
metaphyseal multifragmentary 0,60% of the total
1,00% of the femur
16,82% of the segment

56 fractures
17,1% group
48%M, 52%F

99 fractures
30,2% group
48%M, 52%F

173 fractures
52,7% group
52%M, 48%F

With an intact wedge +Q With a fragmented wedge +Q Complex

These are complete articular fractures of the distal femur involving the articular surface with a simple fracture line while the metaphysis is multifragmented (complex fracture). Ref. Manual of Internal Fixation:
270 - 281. 266 - 269. 548 - 552.
Surgeon. JG, RO.

As in all group C cases, anatomic reduction of the articular fragments is mandatory. The characteristic of this subgroup is the multiple fragments of the metaphysis that, because of its thin cortex, are of little mechanical value and anatomic reduction should not be attempted. It is preferable to retain their biologic value by preserving the blood supply. Appropiate traction with the knee flexed 90º will gather the fragments together around the plate which, in this case, will function as a bridge plate.

The implant used can either be the DCS or the 95º condylar plate. Autologous cancellous bone graft should allways be used in the medial metaphyseal area to compensate for the bone loss caused by the multifragmentation.

preoperative preoperative

+ 1 year + 1 year

preoperative preoperative

+ 4 years + 4 years

These are fractures osimilar in character to the previous subgroup in which the qualification (7) means segmental bone loss. Therefore, they allways are open fractures. Ref. Manual of Internal Fixation:
266 - 269. 415. 548 - 552.
Surgeon. RO.

In the illustrated case, the segmental metaphyseal-diaphyseal bone loss was of 12 cm. The intercondylar fracture was reduced and the bone loss substituted by a frozen homologous massive bone graft. The bone graft was cut oblique at its proximal end, in order to maximize the contact area under compression, while the distal end was molded to match the condyles. The whole assembly was then axially compressed, obtaining a very stable

fixation. One year later, perfect healing at both ends can be observed. Three years later, a fracture through the middle of the bone graft occurred and healed protected by the implant. Eight years later the patient is doing well and even playing sports. The reason for such good result probably is the excellent long lasting primary stability of the internal fixation.

preoperative + 4 months + 4 months

+ 1 year + 1 year

+ 4 years + 4 years

+ 8 years + 8 years




						Femur, Distal, complete articular fracture, articular simple, metaphyseal multifragmentary	0,60% of the total 1,00% of the femur 16,82% of the segment






These are complete articular fractures of the distal femur involving the articular surface with a simple fracture line while the metaphysis is multifragmented (complex fracture).		Ref. Manual of Internal Fixation: 270 - 281. 266 - 269. 548 - 552. Surgeon. JG, RO.

As in all group C cases, anatomic reduction of the articular fragments is mandatory. The characteristic of this subgroup is the multiple fragments of the metaphysis that, because of its thin cortex, are of little mechanical value and anatomic reduction should not be attempted. It is preferable to retain their biologic value by preserving the blood supply. Appropiate traction with the knee flexed 90º will gather the fragments together around the plate which, in this case, will function as a bridge plate.	The implant used can either be the DCS or the 95º condylar plate. Autologous cancellous bone graft should allways be used in the medial metaphyseal area to compensate for the bone loss caused by the multifragmentation.






These are fractures osimilar in character to the previous subgroup in which the qualification (7) means segmental bone loss. Therefore, they allways are open fractures.		Ref. Manual of Internal Fixation: 266 - 269. 415. 548 - 552. Surgeon. RO.

In the illustrated case, the segmental metaphyseal-diaphyseal bone loss was of 12 cm. The intercondylar fracture was reduced and the bone loss substituted by a frozen homologous massive bone graft. The bone graft was cut oblique at its proximal end, in order to maximize the contact area under compression, while the distal end was molded to match the condyles. The whole assembly was then axially compressed, obtaining a very stable	fixation. One year later, perfect healing at both ends can be observed. Three years later, a fracture through the middle of the bone graft occurred and healed protected by the implant. Eight years later the patient is doing well and even playing sports. The reason for such good result probably is the excellent long lasting primary stability of the internal fixation.