Open fractures

A 49-year-old male was involved in a high-speed motor vehicle accident and sustained an open distal femur fracture. He was taken to a local hospital and radiographic examination revealed a right-sided (open) complex distal femur fracture a medial butterfly fragment, comminution and intra-articular extension.

An spanning external fixator was placed to provide initial fracture stabilization and the open wound was irrigated and debrided on multiple occasions. The local medical team then contacted David L. Helfet, MD at the Orthopaedic Trauma Service at the Hospital for Special Surgery to arrange a patient transfer for definitive management of his comminuted distal femur fracture.

Open reduction and Internal Fixation (ORIF) was performed with placement of a locking plate with fixation of the femoral condyles reduction the fractures and restoring alignment and length. He returned for regular follow-up and healed uneventfully. At 1-year following surgery the hardware was removed.

At last follow-up at 1.5 years following fracture surgery he presented with excellent radiographic and clinical results including a healed distal femur fracture, resolution of pain, and a return to pre-injury activities including golf.

  • Figure A

    Figure A

    Anteroposterior (AP) radiographs (left images) and lateral radiographs (right images) revealing a supracondylar distal femur fracture.

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  • Figure B

    Figure B

    CT Scan images further delineating the fracture pattern.

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  • Figure C

    Figure C

    Intraoperative fluoroscopic image following placement of spanning external fixation.

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  • Figure D

    Figure D

    Preoperative plan (left image) and intraoperative fluoroscopic images following open reduction and internal fixation with placement of a femoral locking plate.

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  • Figure E

    Figure E

    AP and lateral radiographs at 6 months post-operative (left images), 16 months (middle images) and 1.5 years (right images). The hardware was removed at 1-year post-operative and the patient resumed all pre-injury activities.

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David L. Helfet, MD

535 East 70th Street
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New York Fracture Care

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