Download PDF
J Knee Surg 2018; 31(09): 905-912
DOI: 10.1055/s-0038-1626734
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Transpatellar Approach to Treat Distal Femoral Type C3 Fractures Combined with Patellar Fractures

Seung Hoo Lee
1   Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
,
Min Bom Kim
1   Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
,
Jae Ang Sim
2   Department of Orthopaedic Surgery, Gachon University Gil Medical Center, Incheon, Republic of Korea
,
Do Hwan Han
1   Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
› Author Affiliations Funding None.
Further Information

Publication History

08 November 2017

23 December 2017

Publication Date:
06 February 2018 (online)

    Permissions and Reprints

Abstract

We report our surgical method used to treat type C distal femur fractures accompanied by patella fractures whereby we approach the articular surface of the femur through the already-fractured patella. We treated 10 patients with type C3 distal femur and patella fractures between May 2013 and April 2015. Because the patella was fractured in all cases, we could approach the articular surface of the distal femur through the transverse gap between the retracted patellar fracture fragments, “transpatellar approach.” Any surgical complications were recorded. Knee function was evaluated using the Böstman system. The average age of the 10 patients (8 males) was 42.9 years (range, 22.0–58.0 years). All distal femur fractures were type C3, combined with patella fractures. Bony union of the distal femur and patella was achieved in all but one patient, who required an additional bone graft (without any change in the implant). Overall, three patients (30%) reported excellent results and seven (70%) reported good results, based on the Böstman system. A midline anterior approach through a patella fracture adequately exposes the entire joint surface of the distal femur, except the posterior surface. This approach is useful when treating a type C distal femur fracture accompanied by a patella fracture. The level of evidence is IV.

Keywords

transpatellar approach - distal femur fracture - patellar fracture

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


 

  • Reference

  • 1 Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta III P. Rockwood and Green's Fractures in Adults. 8th ed. Philadelphia: LWW; 2015: 2229-2266
    Search in Google Scholar
  • 2 Marsh JL, Slongo TF, Agel J. , et al. Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 2007; 21 (10, Suppl): S1-S133
    Search in Google Scholar
  • 3 Johnson KD, Hicken G. Distal femoral fractures. Orthop Clin North Am 1987; 18 (01) 115-132
    PubMedSearch in Google Scholar
  • 4 Rademakers MV, Kerkhoffs GM, Sierevelt IN, Raaymakers EL, Marti RK. Intra-articular fractures of the distal femur: a long-term follow-up study of surgically treated patients. J Orthop Trauma 2004; 18 (04) 213-219
    CrossrefPubMedSearch in Google Scholar
  • 5 Johnson EE. Combined direct and indirect reduction of comminuted four-part intraarticular T-type fractures of the distal femur. Clin Orthop Relat Res 1988; (231) 154-162
    PubMedSearch in Google Scholar
  • 6 Bin Z, Song L, Binghua W, Ping Q, Min D. A new anterolateral approach for type C fractures of the distal femur. Int Surg 2014; 99 (06) 875-879
    CrossrefPubMedSearch in Google Scholar
  • 7 Kim MB, Lee YH, Shin WC, Baek GH. Locked tension band wiring using ring pins for patellar fractures: a method of minimising implant migration. Arch Orthop Trauma Surg 2014; 134 (11) 1537-1543
    CrossrefPubMedSearch in Google Scholar
  • 8 Della Rocca GJ. Displaced patella fractures. J Knee Surg 2013; 26 (05) 293-299
    Thieme ConnectPubMedSearch in Google Scholar
  • 9 Ebraheim NA, Martin A, Sochacki KR, Liu J. Nonunion of distal femoral fractures: a systematic review. Orthop Surg 2013; 5 (01) 46-50
    CrossrefPubMedSearch in Google Scholar
  • 10 Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL. 2010 mid-America Orthopaedic Association Physician in Training Award: healing complications are common after locked plating for distal femur fractures. Clin Orthop Relat Res 2011; 469 (06) 1757-1765
    CrossrefPubMedSearch in Google Scholar
  • 11 Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury 1981; 13 (03) 196-202
    CrossrefPubMedSearch in Google Scholar
  • 12 Donald SM, Bateman ER. Patella osteotomy: a new approach for complex trauma around the knee. J Orthop Trauma 2013; 27 (07) e161-e165
    CrossrefPubMedSearch in Google Scholar
  • 13 Jin J, Ren H, Liu Y, Jin R, Li L. Effectiveness of anterior knee incision by patellar longitudinal approach for osteotomy in treatment of distal femoral type C fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2015; 29 (06) 700-703
    PubMedSearch in Google Scholar
  • 14 Schütz M, Müller M, Regazzoni P. , et al. Use of the less invasive stabilization system (LISS) in patients with distal femoral (AO33) fractures: a prospective multicenter study. Arch Orthop Trauma Surg 2005; 125 (02) 102-108
    CrossrefPubMedSearch in Google Scholar
  • 15 Khalil Ael-S, Ayoub MA. Highly unstable complex C3-type distal femur fracture: can double plating via a modified Olerud extensile approach be a standby solution?. J Orthop Traumatol 2012; 13 (04) 179-188
    CrossrefPubMedSearch in Google Scholar
  • 16 Kim JG, Lim HC, Kim HJ, Hwang MH, Yoon YC, Oh JK. Delayed detection of clinically significant posterior cruciate ligament injury after peri-articular fracture around the knee of 448 patients. Arch Orthop Trauma Surg 2012; 132 (12) 1741-1746
    CrossrefPubMedSearch in Google Scholar