Case Report

A New Pattern of Distal Femoral Unicondylar Fracture in a Middle-Aged Man

Abstract

Background: Distal femoral fractures are not common among all fractures and the incidence rises with age. While this kind of fracture is usually caused by low-energy trauma in the elderly, there are many known fracture patterns. We encountered a new pattern of fracture in a middle-aged man.
Case Presentation: A 56-year-old obese man presented to our hospital with direct trauma from a motor car accident. We encountered a bizarre pattern of distal femoral fracture, which was a biplanar unicondylar fracture in the medial condyle of the femur through physeal remnant. This fracture was similar to the pattern of Salter-Harris type III fracture and unicondylar type of T-type simple articular epiphyseal fracture in Osteosynthesis/Orthopaedic Trauma Association (AO/OTA) classification (type 43.C1.3). The fracture was fixed with two 7.3mm cannulated screws.
Conclusions: A direct trauma to the distal femur can result in different fracture patterns. In our case, a fracture through physeal remnant of the distal femur has occurred in a morbidly obese patient with radiographic signs of osteoarthritis (OA). We hypothesize that the conduction of axial and anterior to posterior forces through the weak epiphyseal line in a patient can cause a new pattern of fracture similar to AO/OTA type 43.C1.3.

 

1. Gangavalli AK, Nwachuku CO. Management of distal femur fractures in adults: An overview of options. Orthop Clin North Am. 2016;47(1):85-96 .doi: 10.1016/j.ocl.2015.08.011. [PubMed: 26614924].

2. Dugan TR, Hubert MG, Siska PA, Pape HC, Tarkin IS. Open supracondylar femur fractures with bone loss in the polytraumatized patient-Timing is everything! Injury. 2013;44(12):1826-31. doi: 10.1016/j.injury.2013.03.018. [PubMed: 23601115].

3. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury. 2006;37(8):691-7. doi: 10.1016/j.injury.2006.04.130. [PubMed: 16814787].

4. Trillat A, Dejour H, Bost J, Nourissat C. Unicondylar fractures of the femur. Rev Chir Orthop Reparatrice Appar. Mot 1975;61(7):611-26. [PubMed: 133422].

5. Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, et al. Fracture and dislocation classification compendium-2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma. 2007;21(10 Suppl):S1-133. doi: 10.1097/00005131- 200711101-00001. [PubMed: 18277234].
6. Raja BK, Arun KC, Dheenadayalan J. Classification of distal femur fractures and their clinical relevance. Trauma International. 2016;2(1):3-6.
7. Neer CS, Grantham SA, Shelton ML. Supracondylar fracture of the adult femur. A study of one hundred and ten cases. J Bone Joint Surg Am. 1967;49(4):591-613. [PubMed: 6025996].
8. Seinsheimer F 3rd. Fractures of the distal femur. Clin Orthop Relat Res. 1980;(153):169-79. [PubMed: 7449211].
9. Bel JC, Court C, Cogan A, Chantelot C, Pietu G, Vandenbussche E. Unicondylar fractures of the distal femur. OrthopTraumatol Surg Res. 2014;100(8):873-7. 10.1016/j.otsr.2014.10.005. [PubMed: 25453913].

10. Haidukewych GJ. Temporary external fixation for the management of complex intra-and periarticular fractures of the lower extremity. J Orthop Trauma. 2002;16(9):678-85. doi: 10.1097/00005131-200210000-00012. [PubMed: 12368651].
11. Arazi M, Memik R, Ogun TC, Yel M. Ilizarov external fixation for severely comminuted supracondylar and intercondylar fractures of the distal femur. J Bone Joint Surg Br. 2001;83(5):663-7. doi: 10.1302/0301-620x.83b5.11520. [PubMed: 11476301].
12. Khalafi A, Hazelwood S, Curtiss S, Wolinsky P. Fixation of the femoral condyles: A mechanical comparison of small and large fragment screw fixation. J Trauma. 2008;64(3):740-4 doi: 10.1097/TA.0b013e318165c12a. [PubMed: 18332817].
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IssueVol 4, No 3 (2018) QRcode
SectionCase Report
DOI https://doi.org/10.18502/jost.v4i3.3083
Keywords
Femur; Femoral Fractures; Intra-Articular Fractures; Classification
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How to Cite
1.
Kalantar SH, Baghdadi S, Dehghani Firoozabadi MJ, Moslemi S, Panahi S. A New Pattern of Distal Femoral Unicondylar Fracture in a Middle-Aged Man. J Orthop Spine Trauma. 2020;4(3):65-68.