Femoral Shaft And Distal Femur Fractures

Front 1

goals of treatment of distal femur fractures

Back 1

anatomic reduction of articular surface
restoration of limb alignment, length, rotation
early mobilization

Front 2

why internal fixation of displaced distal femoral fractures is difficult

Back 2

thin cortices
wide medullary canal
relative osteopenia
fracture comminution

Front 3

mechanisms of injury for distal femur fractures

Back 3

high energy trauma
fall on flexed knee
notching while performing TKA

Front 4

percent of distal femur fractures that are open

Back 4

5-10%
typically anterior proximal to patella with involvement of extensor mechanism

Front 5

imaging for distal femur fractures

Back 5

AP/lat knee and distal femur
traction views

Front 6

factors of distal femur fracture that aren't included in classification systems

Back 6

amount of displacement
degree of comminution
extent of soft-tissue injury
associated neurovascular injuries
magnitude of joint involvement
degree of osteoporosis
presence of multiple trauma
complex ipsilateral injuries (patella/plateau fxs)

Front 7

OTA classification of distal femur fractures

Back 7

A: extra articular
1: simple
2: metaphyseal wedge
3: metaphyseal complex
B: partial articular
1: lateral condyle sagittal
2: medial condyle sagittal
3: frontal
C: complete articular
1: articular simple, metaphyseal simple
2: articular simple, metaphyseal complex
3: multifrag articular

Front 8

supracondylar area of femur

Back 8

zone between the femoral condyles and the junction of the metaphysis with the femoral diaphysis (approximately distal 15 cm of femur)

Front 9

shape of distal femur

Back 9

trapezoidal (narrower anteriorly)

Front 10

angle of inclination of medial distal femur

Back 10

25 degrees

Front 11

predominant contact surface for patella

Back 11

lateral condyle

Front 12

lateral epicondyle

Back 12

arises from lateral condylar surface
gives rise to LCL
immediately below is oblique groove that houses popliteus

Front 13

medial epicondyle

Back 13

longer and extends further distally compared to lateral

Front 14

anatomic axis of femoral shaft relative to knee

Back 14

8 degrees of valgus

Front 15

3 major muscle groups in the thigh

Back 15

hip adductors
knee extensors
knee flexors

Front 16

path of femoral artery and vein

Back 16

anteriomedially through the mid-thigh in Hunter's canal between the extensor and adductor compartments, beneath the sartorius muscle

Front 17

level at which femoral vessels pierce adductor magnus

Back 17

10 cm above the knee to enter posterior compartment

Front 18

bounds of popliteal fossa

Back 18

superiomedially: semimembranosus, semitendinosus
superiolaterally: biceps femoris
inferiorly: 2 heads of gastrocnemius

Front 19

relationship of neurovascular structures in popliteal fossa

Back 19

artery is deep and medial to popliteal vein and tibial nerve

Front 20

most commonly injured ligament associated with distal femur fractures

Back 20

anterior cruciate ligament

Front 21

most common complication following distal femur fracture

Back 21

loss of knee motion 2/2 damage to quadriceps mechanism and joint surface

Front 22

Winquist and Hansen system

Back 22

grade 0: no associated comminution
grade I: small chip or fragment of comminution
grade II: small butterfly fragment, >50% cortex intact
grade III: larger butterfly with minimal cortical abutment
grade IV: no predicted cortical contact, aka segmentally comminuted

Front 23

use of Winquist and Hansen system

Back 23

determine wheter a locking nail should be used and if so, whether it should be locked statically or dynamically

Front 24

AO/OTA femoral shaft fractures

Back 24

A: simple
1: spiral
2: oblique
3: transverse
B: wedge
1: spiral wedge
2: bending wedge
3: segmental wedge
C: complex
1: spiral comminuted
2: segmented
3: irregular

Front 25

anterior bow of femur

Back 25

radius of curvature approximately 120 cm

Front 26

deforming forces of femoral shaft fractures

Back 26

shortening = hamstrings, quadriceps
flexed, abducted = iliopsoas
externally rotated = hip abductors, external rotators
distal frag adducted = adductors

Front 27

anterior compartment of the thigh

Back 27

quadriceps femoris
ilacus
psoas
sartorius
pectineal muscles
femoral artery and vein
femoral nerve
lateral femoral cutaneous nerve

Front 28

posterior compartment of the thigh

Back 28

biceps femoris
semimembranosus
semitendinosus
distal portion of adductor magnus
branches of profundus femoris a
sciatic n
posterior femoral cutaneous n

Front 29

medial compartment of the thigh

Back 29

adductor brevis
adductor longus
most of adductor magnus
gracilis
profundus femoris a
obturator a
obturator n

Front 30

course of external iliac a

Back 30

passes below inguinal lig to be femoral a
gives off profundus which then gives med/lat fem circumflex a and multiple perforators
distally, fem a passes thru hiatus of adductor magnus to become popliteal a

Front 31

blood supply of femur

Back 31

primary nutrient vessels
small periosteal vessels

Front 32

where nutrient vessels goes into femur

Back 32

linea aspera - hence should not be stripped of muscular attachments