With the introduction of angular stable implants, the options for operative treatment have greatly increased. Nonetheless, in 1995, Karpman et al 9 described an above-knee amputation being necessary in 9% of patients with distal femur fractures and osteoporotic bone due to displacement of fractures or infections, proposing primary amputation as a treatment option in selected patients. 7 In 1974, Schatzker et al 8 shared their “Toronto experience” demonstrating good results for internal fixation in 75% of the cases, compared to 32% for nonoperative treatment with an ischial cast, concluding that operative treatment posed a valid therapeutic option. 6 In the 1960s, closed treatment with traction was found to have more satisfactory results compared with patients treated with osteosyntheses. 4, 5 The treatment options have evolved over the past decades due to a better understanding of fracture patterns and biology, as well as the development of biomechanically improved implants. Patients with distal femur fractures aged 80 years or older face high mortality rates of up to 33% after 12 months and 50% after 5 years. Perioperative complication and mortality rates of distal femur fractures are similar to fractures of the proximal femur but have not been assessed as thoroughly. 2, 3 The treatment of geriatic patients can be especially challenging due to poor bone quality, preexisting implants (eg, knee or hip arthroplasty), and impaired compliance during rehabilitation in mentally and physically restricted patients. 1 While these fractures mainly occur due to high-velocity accidents in young patients, low-energy trauma from ground-level falls can cause similar fracture patterns in the elderly population. Open fractures, fractures that cannot be repositioned during a closed reduction, and fractures that are accompanied by nerve or vascular injuries require open surgery or open reduction and internal fixation.Fractures of the distal femur account for approximately 0.4% of all human fractures and 3% to 6% of all femoral fractures. The pins and cast are removed after healing has begun, a few weeks after surgery. A splint is applied to protect the area for the first week, then is typically replaced with a cast. The pins are inserted through the skin, into the bone and across the fracture. In this procedure, the displaced bone fragments are repositioned during closed reduction and held in place with metal pins. If the bone fragments are displaced, surgery may be required to ensure that the fracture heals fully.Ĭlosed reduction and percutaneous pinning. Your doctor may schedule additional x-rays to make sure the bones stay in place as they heal. Your child will be given some form of sedation or anesthesia for this procedure. In this procedure-called a closed reduction-your doctor gently moves the arm to manipulate the bones back into place. In some stable elbow fractures, the bones may need to be repositioned before applying a splint or cast. As swelling subsides, a full cast may replace the splint. In many cases, a splint is applied to a fresh injury first. Splints provide less support than casts however, they can be easily adjusted to accommodate swelling from injuries. If the fracture is stable with no displacement, your doctor may directly apply a splint or cast to keep the bones in proper alignment while they heal. Many stable fractures heal successfully with cast or splint immobilization. Treatment for elbow fractures depends on the type of fracture and the degree of displacement. For this reason, it is important that the fracture be treated correctly at the time of the initial injury. If an elbow fracture heals in the wrong position, the elbow may remain permanently crooked and have limited range of motion. An open fracture may involve damage to the muscles, tendons, and ligaments and take a longer time to heal. When a broken bone breaks through the skin, it is called an open fracture. If the dislocation is not recognized, and only the fracture is treated, it can lead to permanent impairment of elbow joint function. A fracture of the ulna associated with a dislocation of the top of the radius at the elbow is called a Monteggia fracture. Fractures of the tip (olecranon) of the ulna are rare.įracture dislocation. Because growth plates help determine the length and shape of the mature bone, a fracture that disrupts the growth plate can result in arrested growth and/or deformity if not treated promptly.įorearm. A fracture can occur at the top (head) of the radius bone, causing it to move out of place. The upper arm bone and both forearm bones have areas of cartilage called growth plates located near the end of the bone. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003. Reproduced and adapted from J Bernstein, ed: Musculoskeletal Medicine.
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