Introduction

Distal femur fractures are complex injuries. Their aetiology includes high-energy traumas in young patients, often combined with polytrauma or combined fractures (e.g. dashboard injury), and low-energy traumas usually in elderly patients associated with reduced bone quality.

Clinical assessment

• Check for pain, swelling, deformity, shortening and intra-articular effusion.

• Assess the neurovascular status of the leg and soft tissue damage of closed fractures.

• In case of diminished or absent pulse the ankle-brachial indices as well as a Doppler should be done early. In doubt, in case of side-to-side difference, or if a value of less than 0.9 occurs, an arteriogram is indicated.

• Open fractures: do not open dressings placed on the scene out of the operating room. Information about local wound findings requires a clear medical handover.

• Assess local injury severity with the Abbreviated Injury Scale (AIS) and the total severity of injuries with the Injury Severity Score (ISS).

• Check for previous surgery, especially total hip arthroplasty (THA) and total knee arthroplasty (TKA).

• Be aware of typically associated injuries: calcaneus, proximal tibia fracture, patella fracture, ligament ruptures of the knee (posterior cruciate ligament), femoral neck fracture, femoral head fracture, acetabulum fracture.