Distal Femoral Replacement in Young Adults with Traumatic Comminuted Distal Femur Fractures: A Report of Two Cases

Distal femur fractures (DFFs) are uncommon injuries that predominantly affect elderly patients and are usually managed with internal fixation. In young adults, distal femoral replacement (DFR) is rarely considered and is typically reserved for elderly or oncologic indications. We report two young, previously healthy patients with traumatic, non-reconstructible DFFs treated with DFR and describe their outcomes.

Two 25-year-old patients, one female and one male, sustained high-energy DFFs with severe comminution and intra-articular destruction. In both cases, internal fixation was not feasible because of extensive bone loss and irreversible joint damage. Following multidisciplinary evaluation, DFR was performed as a salvage procedure. Both patients were allowed early weight-bearing and achieved functional ambulation. One patient developed aseptic loosening that required revision surgery; however, both patients ultimately demonstrated satisfactory pain control, knee stability, and functional recovery.

DFR may represent a viable salvage option in carefully selected young adults with non-reconstructible traumatic DFFs. These cases highlight an uncommon indication for DFR and add novel clinical insight to orthopedic trauma practice, although long-term durability in this population remains uncertain.