Kregor and Michael P. Complications are significant and include infection, knee stiffness, malunion, nonunion, and the need for bone grafting.
Although the fractures healed without significant difficulty when treated non operatively, there was significant deformity and joint stiffness afterward. With this experience in mind, surgeons began to utilize techniques of open reduction and rigid internal fixation that were popularized by the AO group in the mids.
These devices provided sufficient fixation to enable early range of motion, decreased stiffness, and improved mobility of the patient. These early surgical techniques were associated, however, with a significant risk of infection and need for bone grafting.
Both of these complications were attributed to the relatively large surgical exposures utilized in the early experience with open reduction and internal fixation of these fractures. The concept of biological plating was developed by Mast, Jakob, and Ganz.
Bolhofner et al 12 demonstrated the efficacy of biological plating for supracondylar femur fractures. Since then, multiple series have documented the effectiveness of indirect reduction techniques for the repair of supracondylar femur fractures. This was accomplished by one of two surgical techniques popularized in the s. The first was the use of retrograde intramedullary nailing.
The second was the use of sub-muscular plating to maintain the soft tissues around the distal femur fracture. As with retrograde nailing of the femur, the nonunion and infection rates are quite low. A significant advance in the evolution of the treatment of distal femur fractures was the utilization of locked internal fixators for the distal femur.
Previously, maintenance of reduction of the distal femoral block, especially in the setting of significant osteoporosis or a short distal segment, was a significant concern. Return to former activities and a good functional outcome as assessed by modern-day functional outcome instruments.
Müller AO Classification of fractures
With these goals in mind, the surgeon should be able to classify the fracture, decide on operative versus nonoperative treatment, decide on the mode of treatment, and be able to predict certain outcomes based on the treatment. This chapter explores in detail each of these aspects of the care of these difficult fractures.
A good classification scheme should help to determine the surgical approach and treatment as well as the prognosis for a particular injury.
Fractures are categorized into three types: type A, extra-articular; type B, partial articular; and type C, complete intra-articular with dissociation from the diaphysis. To use this classification, good quality radiographs are essential.Soalan matematik tahun 3 kertas 2
If there is any question regarding the characterization of the injury, the surgeon should obtain anteroposterior APlateral, and oblique traction views. A computed tomography CT scan with frontal and sagittal reconstructions may be utilized to characterize the articular injury. Key questions to be answered with the help of these radiographs are the following:. The answer to the first question differentiates between a type A and a type C fracture. The answers to the third and fourth questions enable the surgeon to decide if an extensile lateral parapatellar approach or less extensile approach anterolateral approach is needed.
Classification of a fracture as a type B partial articular injury is an accurate description of the condyle fracture, whether it is a medial condyle, lateral condyle, or frontal plane fracture. This has significance in terms of the surgical approach and the implant. InStewart et al 5 reported on the treatment of supracondylar femur fractures, and reached a similar conclusion. These observations, however, were made a half-century ago, and it is clear that with appropriate intervention the clinical results of internal fixation have significantly improved since the s.
For example, to have a satisfactory Neer score, the patient could still have pain with fatigue, restricted function for example, needing to climb the stairs sidewaysknee motion of only degrees, and up to 5 degrees of angulation or 0.
These rare situations might include a nonambulatory patient, a patient with significant comorbidities, and a patient with a very short life expectancy.The surgeon confronted with a type A fracture of the distal femur must ensure that it is not a type C fracture.
Careful scrutiny of the plain radiographs is the key. Adjuncts in the diagnosis would be traction x-rays, oblique x-rays, and a CT-scan of the distal femur with frontal and sagittal reconstruction views. If an intraarticular extension is determined, the surgeon has defined a type C injury. Type C injuries of the distal femur are either the result of high-energy trauma in the younger patient, or simple falls in the elderly, osteoporotic patient.
Distal femoral fractures - management principles and technique options. Lecturer: Matthew R Camuso. Duration: minutes. Level of knowledge: Basic. Lecturer: Hazem Azeem. Level of knowledge: Complex. Femoral shaft and distal femur: treatment options and analysis of failed cases. Lecturer: M Lutz. Lecturer: Carlos Mario Olarte Salazar. Approaches to distal femur fractures.
Executive Editor: Chris Colton. Reduction and fixation of distal femur fractures. Gebhard F, Kinzl L. Femur, distal.
AO Principles of Fracture Management. Level of knowledge: Basic to intermediate.Mp3 to midi fl studio mobile
Classification of FracturesLong Bones. This leaflet is designed to provide an introduction to the classification of long-bone fractures. Illustrations for download: Classification of femur fractures. Femur, distal A extraarticular fracture Type A fracture of the distal femur are extraarticular, these fractures do not involve the articular surface but may be within the capsule of the joint.Scaldacuore neonata ai ferri
Available learning resources Videos — AO Trauma members only Condylar plate fixation in the distal femur. Consultant: Roland P. Consultant: Ren Grass. Level of knowledge: Intermediate to complex Intraarticular distal femoral fracture C2. Consultants: Hermann J. Duration: Level of knowledge: Complex Femoral shaft and distal femur: treatment options and analysis of failed cases.
Suggested readings Gebhard F, Kinzl L. Condylar plate fixation in the distal femur. Level of knowledge: Intermediate to complex. Distal femoral nail DFN. Intraarticular distal femoral fracture C2.Average 4. Which of the following descriptions matches this classification? Tested Concept. Distal third tibial shaft fracture with extensive soft tissue injury and a pale foot following adequate closed reduction.
Posterolateral ankle fracture-dislocation with 8cm laceration on medial ankle, amenable to primary closure. Midshaft tibia fracture with 1cm anterior laceration requiring compartment releases intraoperatively. Proximal third tibial shaft fracture with extensive soft tissue loss requiring gastrocnemius flap. Closed pilon fracture that will require delayed surgical fixation after initial external fixation. No vascular injury is identified. What is the most appropriate Gustilo-Anderson classification of this injury?
Gustilo Classification. Michael Torchia. Benjamin C. Key Images. Topic Rating. Please rate topic. Upgrade to PEAK. Tested Concept QID: L 1 Question Complexity. Question Importance. L 5 Question Complexity. Sort by. All Videos 0 Podcasts 1. Orthobullets Team. Listen Now min. Open injury of the dorsal surface of the forefoot exposed tendon and 1st MTP joint C Panagiotis Poulios.
Please login to add comment. Cancel Save.Surgeons have understood the complexities of treating distal femoral fractures in the elderly for many years, but it has only been in the last 30 years that different fixation techniques and their outcome have been examined in detail. Wade and Okinaka 1 in reported on 23 patients with supracondylar femoral fractures, of which 18 were in women and the majority were in their eighth decade.
They stated that the predisposing causes of fracture were osteoporosis, pre-existing disabilities of the hip and knee and other medical comorbidities. They noted that the mortality and the time patients spent in hospital were very similar in both patient groups, although they thought that patients treated surgically often had greater comorbidities.
They favoured using a blade plate for operative management, but they also used intramedullary nailing.
These are becoming progressively more common. In Chapter 1 distal femoral fractures were shown to comprise 0. To permit a more detailed assessment of the epidemiology of distal femoral fractures in the elderly, a year study of all distal femoral fractures admitted to the Royal Infirmary of Edinburgh between and was undertaken.
During this period patients were admitted of whom The average age of all patients who presented with a distal femoral fracture was The average age of patients who presented with distal femoral periprosthetic fractures was A total of Figure However, the fracture distribution curves for type B and type C fractures are different.
Elderly females show the same increasing incidence with increasing age, but in type B fractures the incidence in males declines after 85 years and in type C fractures the incidence declines after 70 years of age.John travolta daughter 2020
This suggests increasing male frailty compared with elderly females. Periprosthetic fractures have similar fracture distribution curves to type B and C fractures with an increasing fracture incidence in older females and a decline in incidence in males over 80 years of age.
Overall, It is interesting to observe that there were no metastatic distal femoral fractures, although 8. Only 1. Both Wade and Okinaka 1 and Kolmert and Wulff 2 pointed out that many elderly patients who present with distal femoral fractures will often be infirm and in poor health.
This continues to be the case and analysis of the data in the year study shows that only Only The remaining 3. The older age of the patients with the distal femoral periprosthetic fractures probably accounts for the fact that while Open distal femoral fractures are very rare in the elderly population.
A review of the distal femoral fractures treated in the year period showed that only six 2. There were five 2.It is one of the few complete fracture classification systems to remain in use today after validation.
The English language version of the system  allows consistent in detail description of a fracture in defined terminology by creating a 5-element alphanumeric code:.
First, each fracture is given 2 numbers to describe which bone it affects, and where in the bone:. Each fracture is next given a letter A, B or C to describe the joint involvement of the fracture:. Subgroups are then used to describe the fractures in terms of displacement versus apposition, which is the degree to which the parts are in contact with each otherrotation, angulation and shortening.
A pediatric version of the long-bone classification was published in  to further classify fractures of immature bone and so the effects on future growth:.
The Orthopaedic Trauma Association Committee for Coding and Classification initially published their classification system covering the whole skeleton in From Wikipedia, the free encyclopedia. Classification AO des fractures. Tome I. Les os longs. Berlin: Springer-Verlag. A systematic review of their methodologies".
Acta Orthop Scand. New York: Springer-Verlag. J Pediatr Orthop. J Orthop Trauma. Spine J. Fractures of the Pelvis and Acetabulum. J Bone Joint Surg Am. Handchir Mikrochir Plast Chir. AO Classification of Mandibular Fractures. CS1 maint: extra text: authors list link. Fractures and cartilage damage. Avulsion fracture Chalkstick fracture Greenstick fracture Open fracture Pathologic fracture Spiral fracture.
Basilar skull fracture Blowout fracture Mandibular fracture Nasal fracture Le Fort fracture of skull Zygomaticomaxillary complex fracture Zygoma fracture. Cervical fracture Jefferson fracture Hangman's fracture Flexion teardrop fracture Clay-shoveler fracture Burst fracture Compression fracture Chance fracture Holdsworth fracture. Rib fracture Sternal fracture. Clavicle Scapular. Proximal Supracondylar Holstein—Lewis fracture. Scaphoid Rolando Bennett's Boxer's Busch's. Duverney fracture Pipkin fracture.
Bumper fracture Segond fracture Gosselin fracture Toddler's fracture Pilon fracture Plafond fracture Tillaux fracture. Maisonneuve fracture Le Fort fracture of ankle Bosworth fracture.The AO classification of clavicular fractures along with the Neer classification system is one of the more frequently used classification systems when assessing distal clavicular fractures.
The classification system, broken into three categories focuses on the displacement and pattern of the fracture and the integrity of the coracoclavicular ligaments.
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Unable to process the form. Check for errors and try again. Thank you for updating your details. Log In. Sign Up. Become a Gold Supporter and see no ads. Log in Sign up. Articles Cases Courses Quiz. About Blog Go ad-free. Classification The classification system, broken into three categories focuses on the displacement and pattern of the fracture and the integrity of the coracoclavicular ligaments.
Type A A1 when the fracture is extra-articular. Quiz questions. Richard E. Buckley, Christopher G. Moran, Theerachai Apivatthakakul. AO Principles of Fracture Management. Edit article Share article View revision history Report problem with Article.
URL of Article. Article information. System: Musculoskeletal. Section: Classifications. Tags: casesrefs. Loading more images Close Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Loading Stack - 0 images remaining.
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