Surgical Techniques   |    
Internal Fixation of Type-C Distal Femoral Fractures in Osteoporotic BoneSurgical Technique
Thomas Mückley, MD1; Dirk Wähnert, MD1; Konrad L. Hoffmeier, Dipl-Ing1; Geert von Oldenburg, Dipl-Ing2; Rosemarie Fröber, MD3; Gunther O. Hofmann, MD, Dr rer nat1
1 Department of Traumatology, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, D-07747 Jena, Germany. E-mail address for D. Wähnert: Dirk.Waehnert@ukmuenster.de
2 Stryker Trauma GmbH, Prof.-Küntscher-Strasse 1–5, D-24232 Schönkirchen/Kiel, Germany
3 Department of Anatomy I, Friedrich Schiller University Jena, Teichgraben 7, D-07743 Jena, Germany
View Disclosures and Other Information
DISCLOSURE: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Stryker Trauma GmbH. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (Stryker Trauma GmbH).

Investigation performed at the Department of Traumatology, Hand and Reconstructive Surgery, Friedrich Schiller University Jena, Jena, Germany
The original scientific article in which the surgical technique was presented was published in JBJS Vol. 92-A, pp. 1442-52, June 2010
The line drawings in this article are the work of Jennifer Fairman (jfairman@fairmanstudios.com).

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Mar 16;93(Supplement 1):40-53. doi: 10.2106/JBJS.J.01142
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



Fixation of distal femoral fractures remains a challenge, especially in osteoporotic bone. This study was performed to investigate the biomechanical stability of four different fixation devices for the treatment of comminuted distal femoral fractures in osteoporotic bone.


Four fixation devices were investigated biomechanically under torsional and axial loading. Three intramedullary nails, differing in the mechanism of distal locking (with two lateral-to-medial screws in one construct, one screw and one spiral blade in another construct, and four screws [two oblique and two lateral-to-medial with medial nuts] in the third), and one angular stable plate were used. All constructs were tested in an osteoporotic synthetic bone model of an AO/ASIF type 33-C2 fracture. Two nail constructs (the one-screw and spiral blade construct and the four-screw construct) were also compared under axial loading in eight pairs of fresh-frozen human cadaveric femora.


The angular stable plate constructs had significantly higher torsional stiffness than the other constructs; the intramedullary nail with four-screw distal locking achieved nearly comparable results. Furthermore, the four-screw distal locking construct had the greatest torsional strength. Axial stiffness was also the highest for the four-screw distal locking device; the lowest values were achieved with the angular stable plate. The ranking of the constructs for axial cycles to failure was the four-screw locking construct, with the highest number of cycles, followed by the angular stable plate, the spiral blade construct, and two-screw fixation. The findings in the human cadaveric bone were comparable with those in the synthetic bone model. Failure modes under cyclic axial load were comparable for the synthetic and human bone models.


The findings of this study support the concept that, for intramedullary nails, the kind of distal interlocking pattern affects the stabilization of distal femoral fractures. Four-screw distal locking provides the highest axial stability and nearly comparable torsional stability to that of the angular stable plate; the four-screw distal interlocking construct was found to have the best combined (torsional and axial) biomechanical stability.


The enhanced distal interlocking stability of the four-screw distal locking construct may be beneficial to the stabilization of complex distal femoral fractures, especially in osteoporotic bone.


"Internal Fixation of Type-C Distal Femoral Fractures in Osteoporotic Bone" (2010;92:1442-52).

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    Oregon - The Center - Orthopedic and Neurosurgical Care and Research
    Massachusetts - The University of Massachusetts Medical School
    Ohio - OhioHealth Research and Innovation Institute (OHRI)