Current Concepts in the Treatment of Distal Femur Fractures in Adults

Distal femur fractures account for approximately 1% of all fractures and 3 to 7% of femoral fractures, representing complex injuries that frequently affect articular surfaces. Computed tomography is essential to evaluate articular involvement, the presence of coronal fracture lines, and metaphyseal comminution. Surgical treatment aims to restore mechanical alignment and articular congruity while providing sufficient stability to allow early mobilization. The epidemiology shows a bimodal pattern: in younger patients, high-energy trauma predominates, whereas in older patients, low-energy falls are more common, with higher mortality related to osteoporosis and comorbidities. Conservative treatment has limited indications and is often reserved for patients with high surgical risk or for nondisplaced fractures. Surgical management includes locking plates, retrograde intramedullary nails, and combined fixation techniques. Dual fixation has gained increasing attention in osteoporotic bone, cases with loss of medial support, and periprosthetic fractures. In selected cases, particularly in older patients with severely compromised bone quality, knee arthroplasty may be an alternative for early mobilization. The present article presents an updated review of the main epidemiological, diagnostic, and therapeutic aspects of distal femur fractures, including special situations such as open fractures, Hoffa fractures, and periprosthetic fractures. Complications such as infection, nonunion, stiffness, and posttraumatic osteoarthritis remain frequent.