Distal Femoral Arthroplasty Versus Open Reduction Internal Fixation for Comminuted Osteoporotic Supracondylar Distal Femur Fractures

Purpose: The purpose of the article is to review the treatment of comminuted distal femur fractures and examine the risks and benefits of distal femoral replacement/arthroplasty (DFA) for the treatment of complicated osteopenic supracondylar femur fractures. Method: An OVID MEDLINE, PubMed, and Cochrane Database of Systematic Reviews literature search was conducted with search terms distal femur fracture, distal femoral replacement, osteoporosis, fixation, and functional outcomes. Forty-six articles pertinent to the topic were retrieved. These articles serve as the basis for the clinical review portion of the article. A patient representing the clinical question was selected for inclusion in the case study. Verbal consent was obtained, consistent with the guidelines from the Journal of Orthopaedics for Physician Assistants. Results: There is a paucity of evidence-based literature to justify the use of distal femoral replacement/DFA for the management of comminuted supracondylar distal femur fractures. Further study is needed to document the role of DFA for frail, elderly patients. Conclusion: Open reduction internal fixation has been used to treat distal femur fractures. The techniques of locked plating (with or without variable angle construct), percutaneous fixation, and intramedullary nailing are well established for the treatment of fractures of the distal femur. The use of distal femoral replacement/DFA has been shown to decrease weight-bearing limitations, decrease immobility, minimize the use of a brace, and maximize function after complicated fractures with osteoporosis. Further research is needed to identify the role of DFA for the treatment of comminuted distal femur fractures in the elderly population.