Distal femur fractures with complex articular involvement: management by articular exposure and submuscular fixation

The A.O./O.T.A. C3 distal femur fracture is characterized by complex articular involvement and is often accompanied by a very short distal femur segment, small osteochondral fragments, and high-energy soft tissue disruption. Current fixation strategies do not provide for optimal visualization/reduction of the articular surface in conjunction with stable fixation of the distal femoral block. Malunion, loss of fixation, need for supplemental fixation, and need for bone grafting is common in the treatment of the C3 distal femur fracture. The transarticular percutaneous osteosynthesis technique, popularized by Krettek, et al, utilizes a lateral peripatellar approach for optimal articular visualization and submuscular fixation for minimal devitalization. In this article, its use is described, as well as reduction and fixation strategies for the articular surface.