Distal Femoral Fracture Fixation

Indications

  • Displaced extra-articular and intra-articular fractures
  • Periprosthetic fractures above a knee replacement
  • Distal femoral replacement for comminuted osteoporotic fractures in older patients
  • Bimodal distribution with young high energy and older low energy fractures
  • Non-operative care only for patients unfit for surgery

Position

  • Supine, radiolucent table, bump under the knee
  • Image intensifier from the opposite side
  • Check rotation with the lesser trochanter profile and the opposite leg

Operative Steps

  1. Fix the articular block first with lag screws
  2. Coronal Hoffa fragments need anterior to posterior screws
  3. Lateral parapatellar approach for complex articular fractures
  4. Restore length, alignment and rotation
  5. Lateral locking plate through a minimally invasive approach, or retrograde nail for extra-articular fractures in good bone
  6. Use a long plate and spread screws to avoid an overly stiff construct
  7. Avoid varus and hyperextension of the distal segment
  8. Medial plate supplementation for medial comminution or osteoporotic bone
  9. Nail plate combinations allow early weight bearing in older patients

Postoperative Care

  • Early knee motion
  • Protected weight bearing for 6 to 12 weeks
  • VTE prophylaxis
  • Radiographs at 2, 6 and 12 weeks
  • Osteoporosis treatment in older patients

Complications

  • Nonunion, often with stiff plate constructs
  • Valgus and rotational malunion
  • Knee stiffness
  • Implant failure
  • Knee stiffness
  • Infection, higher with open fractures
  • Implant failure

Related Pages

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.