[Distal femoral fractures]

Techniques of operative treatment of supra- and intercondylar fractures have changed in recent years. These changes refer to reduction techniques and implant selection. Operative approach concepts, which remained unchanged for several decades were critically evaluated and modified to a minimal invasive osteosynthesis [MIO]. This included for intraarticular fractures a trans-articular joint reconstruction and a retrograde plate osteosynthesis (TARPO). This technique result in better operative visualization and management of intraarticular comminution, saver fracture healing and better functional outcome. For extraarticular fractures a minimally invasive percutaneous plate osteosynthesis (MIPPO) via stab incisions only or retrograde intramedullary nailing is available. Beside that new strategies and techniques for the avoidance of axial malalignment, rotational deformities and leg length discrepancies are described, as well as a new plate generation (LISS: less invasive stabilization system), which behaves more like an internal fixator. The complex nature of combined fractures and soft tissue injuries of the distal femur and proximal tibia needs special attention and specific management. Distal femoral and proximal tibial fractures in young patients are usually caused by a high energy trauma. They are complicated by a high rate of systemic and local injuries to cartilage, ligaments and skin. The patients in this group with severe injuries need a detailed treatment algorithm, because the surgeon's individual skill, enthusiasm and wishful thinking frequently led to unsatisfactory results. A decision making scheme is presented specifically addressing timing and treatment modalities.