Background
Fractures of the distal femur are common and periprosthetic fractures are becoming more prevalent. Muscle attachments often cause shortening, varus displacement and an extension deformity, which must be addressed at reduction.1–4 We describe the use of a posterior reduction device (PORD™; Orthofix, Bussolengo, Italy) to successfully achieve closed reduction and fixation of periprosthetic fractures of the distal femur.
Technique
The PORD™ is attached to a standard traction table with clamps. The patient lies in the supine position and gentle longitudinal traction is applied (Fig 1). The PORD™ is placed under the distal femur. It acts as a fulcrum, against which the lower limb is flexed while maintaining traction. This relaxes the gastrocnemius and soleus complex, providing a counterforce to the muscle pull. As such, longitudinal, sagittal and rotational displacement can all be controlled during surgery. Coronal displacement is overcome by reduction on to or with the plate.
Figure 1.
Patient positioning on traction table using PORD™
Discussion
The PORD™ is designed and marketed predominantly for the assistance in reduction of proximal femoral fractures on a traction table. It has not been described in the use of reduction of fractures of the distal femur. Others have described the concept of a PORD™ in the form of a bolster, rolled up towels, a padded drip stand or even a crutch3,4 but maintaining reduction can be challenging with these devices and they cannot be used with a traction table. Furthermore, the PORD™ facilitates easy use of the image intensifier. We have found that the PORD™ is a powerful tool, enabling a stable anatomic reduction to be achieved and maintained even for very distal periprosthetic fractures (Figs 2–4).
Figure 2.
Anteroposterior (left) and lateral (right) radiography showing supracondylar periprosthetic fracture of right distal femur
Figure 3.
Image intensifier projection showing lateral view of supracondylar periprosthetic fracture of right distal femur with the PORD™ being positioned too proximally (left) and correctly (right) on femur
Figure 4.
Anteroposterior (left) and lateral (right) radiography showing successfully reduced supracondylar periprosthetic fracture of right distal femur using plate fixation
References
- 1.Crist BD, Della Rocca GJ, Murtha YM. Treatment of acute distal femur fractures. Orthopedics 2008; 31: 681–690. [DOI] [PubMed] [Google Scholar]
- 2.AO Surgery Reference (Distal Femur 33-A1.2/3 ORIF). AO Foundation. http://www.aofoundation.org/ (cited July 2014).
- 3.Magu NK, Kulkarni GS. Chapter 218: Fractures of the Distal Femur. In: Kulkarni GS. Textbook of Orthopedics and Trauma. 2nd edn. New Delhi, India: Jaypee Brothers; 2008. [Google Scholar]
- 4.Riehl JT, Widmaier JC. Techniques of obtaining and maintaining reduction during nailing of femur fractures. Orthopedics 2009; 32: 581. [DOI] [PubMed] [Google Scholar]