M.E.Müller: Atlas: Fracture 33-C3

Femur, Distal,
complete articular fracture,
articular multifragmentary 0,34% of the total
0,56% of the femur
9,49% of the segment

27 fractures
14,6% group
46%M, 54%F

65 fractures
35,1% group
48%M, 52%F

93 fractures
50,3% group
58%M, 42%F

Metaphyseal simple Metaphyseal multifragmetary Metaphysio-diaphyseal multifragmetary

... ..
Surgeon. RO.

..

..

preoperative preoperative

0 months 0 months

0 months 0 months

+ 4 months + 4 months

+ 4 months + 4 months

These are complete articular fractures of the distal femur with multiple fragmentation involving both the articular and the metaphyseal areas. Ref. Manual of Internal Fixation:
216 - 217. 415. 548 - 552.
Surgeon. RO.

Reconstruction of the articular surface is essential. In the illustrated case, the articular fracture combines a simple intercondylar fracture with a Hoffa fracture. First, the frontal plane fracture must be reduced and fixed, followed by the sagittal plane intercondylar fracture. It is essential

to use the condylar plate with screws to stabilize the metaphyseal fracture since both the blade of the 95º condylar plate and the big screw of the DCS would interfere with the essential antero-posterior cancellous screws used to fix the Hoffa fracture.

preoperative preoperative

postoperative postoperative

+ 4 years + 4 years

This subgroup of complete articular fractures of the distal femur shares its characteristics with the previously described C3.2, from which it differs in being more extensive, also involving the diaphysis with multiple fragmentation. These are the most complex fractures of the type and the ones in which the treatment is the most difficult. They probably are the most difficult fractures to treat among all fractures of the skeleton. Ref. Manual of Internal Fixation:
266 - 269. 415. 548 - 552.
Surgeon. RO, JC - JLI.

The illustrated cases show the enormous complexity of these fractures as well as the possibility to obtain very acceptable reductions and stable internal fixations with the 95º condylar plates, with early articular function.

The case shown on the lower half of the page is an explosive gun shot wound open fracture and it is a supreme example of surgical technique. The tibial tuberosity screw indicates the osteotomy approach performed in order to obtain enough exposure for the exact reconstruction of the articular surface.

preoperative postoperative + 7 months

preoperative postoperative + 2 years

The subgroup has been described on the previous page. The qualification (7) means segmental bone loss. These are, therefore, open fractures. Ref. Manual of Internal Fixation:
216 - 217. 415. 548 - 552.
Surgeon. RO.

The illustrated case, with a 12 cm segmental bone loss and an associated multifragmentary patellar fracture, was internally fixed with a double plate and packed with bone graft from the iliac crest and the patella (patellectomy). The medial plate was removed 4 years later. Fifteen

years later the patient is active in sports (motorcycle racing) and maintains a 0º-100º range of motion.

This case serves for comparison with the treatment performed in the 33-C2.3(7) case.

preoperative + 4 months + 4 months

+ 1 year + 1 year 15 years 15 years




						Femur, Distal, complete articular fracture, articular multifragmentary	0,34% of the total 0,56% of the femur 9,49% of the segment






These are complete articular fractures of the distal femur with multiple fragmentation involving both the articular and the metaphyseal areas.		Ref. Manual of Internal Fixation: 216 - 217. 415. 548 - 552. Surgeon. RO.

Reconstruction of the articular surface is essential. In the illustrated case, the articular fracture combines a simple intercondylar fracture with a Hoffa fracture. First, the frontal plane fracture must be reduced and fixed, followed by the sagittal plane intercondylar fracture. It is essential	to use the condylar plate with screws to stabilize the metaphyseal fracture since both the blade of the 95º condylar plate and the big screw of the DCS would interfere with the essential antero-posterior cancellous screws used to fix the Hoffa fracture.






This subgroup of complete articular fractures of the distal femur shares its characteristics with the previously described C3.2, from which it differs in being more extensive, also involving the diaphysis with multiple fragmentation. These are the most complex fractures of the type and the ones in which the treatment is the most difficult. They probably are the most difficult fractures to treat among all fractures of the skeleton.		Ref. Manual of Internal Fixation: 266 - 269. 415. 548 - 552. Surgeon. RO, JC - JLI.

The illustrated cases show the enormous complexity of these fractures as well as the possibility to obtain very acceptable reductions and stable internal fixations with the 95º condylar plates, with early articular function.	The case shown on the lower half of the page is an explosive gun shot wound open fracture and it is a supreme example of surgical technique. The tibial tuberosity screw indicates the osteotomy approach performed in order to obtain enough exposure for the exact reconstruction of the articular surface.






The subgroup has been described on the previous page. The qualification (7) means segmental bone loss. These are, therefore, open fractures.		Ref. Manual of Internal Fixation: 216 - 217. 415. 548 - 552. Surgeon. RO.

The illustrated case, with a 12 cm segmental bone loss and an associated multifragmentary patellar fracture, was internally fixed with a double plate and packed with bone graft from the iliac crest and the patella (patellectomy). The medial plate was removed 4 years later. Fifteen	years later the patient is active in sports (motorcycle racing) and maintains a 0º-100º range of motion. This case serves for comparison with the treatment performed in the 33-C2.3(7) case.