Description
In this presentation at the 2021 Trauma Symposium, Matthew Moran, a consultant orthopedic surgeon from the Royal Infirmary of Edinburgh, discusses distal femur fractures and the evolving role of arthroplasty in their treatment. He outlines that arthroplasty is primarily indicated for managing these fractures, particularly in elderly patients—majority being women in their 70s—sustaining injuries from low-energy falls. He emphasizes that historical perspectives on the difficulties of fixing these fractures have shifted, as new techniques and improved implants have led to significantly lower failure rates than previously experienced.
Moran explores different scenarios necessitating distal femoral replacement: periprosthetic fractures, fractures of the native distal femur, and pathologic fractures. He notes that while the approach to treat periprosthetic fractures typically favors fixation, arthroplasty becomes relevant in cases where prior implants were malfunctioning or in the presence of poor bone quality.
He elaborates on several essential factors affecting surgical outcomes, such as ensuring adequate reduction and addressing medial comminution to prevent failure. Furthermore, he underscores the importance of utilizing advanced imaging techniques like CT scans to assess fracture complexities before surgery.
Moran concludes by highlighting the limited yet critical role of arthroplasty in pathologic fractures, indicating that a multi-disciplinary approach is often necessary for optimal patient management. Overall, the presentation reflects a significant shift in managing distal femur fractures, moving towards more personalized and technically sophisticated treatment approaches.