Abstract：
Recent studies report the overall incidence of distal femur fractures as 8.7/100,000/year. This incidence is expected to rise with high energy motor vehicle collisions and elderly osteoporotic fractures in native and prosthetic knees keep increasing. These fractures are more common in males in the younger age spectrum while females predominate for elderly osteoporotic fractures. Surgical treatment is recommended for these fractures to maintain articular congruity, enable early joint motion and assisted ambulation. Over the last two decades, development of minimally invasive and quadriceps sparing surgical approaches, availability of angle stable implants have helped achieve predictable healing and early return to function in these patients. Currently, laterally positioned locked plate is the implant of choice across all fracture patterns. Retrograde with capital implantation of intramedullary nails with provision for multiplanar distal locking is preferred for extra-articular and partial articular fractures. Even with these advancements, nonunion after distal femur fracture fixation can be as high as 19%. Further recent research has helped us understand the biomechanical limitations and healing problems with lateral locked plate fixation and intramedullary nails. This has lead to development of more robust constructs such as nail-plate and double plate constructs aiming for improved construct strength and to minimise failures. Early results with these combination constructs have shown promise in high risk situations such as fractures with extensive metaphyseal fragmentation, osteoporosis and periprosthetic fractures. These constructs however, run the risk of being over stiff and can inhibit healing if not kept balanced. The ideal stiffness that is needed for fracture healing is not clearly known and current research in this domain has lead to the development of smart implants which are expected to evolve and may help improve clinical results in future.
摘要：
最近的研究报告股骨远端骨折的总发生率为8.7/100,000/年。随着高能机动车碰撞和老年人骨质疏松性骨折的增加，这种发生率预计会上升。这些骨折在年轻年龄段的男性中更为常见，而女性则主要是老年骨质疏松性骨折。建议对这些骨折进行手术治疗，以保持关节的一致性，使早期关节运动和辅助步行。在过去的二十年里，微创和股四头肌保留手术方法的发展，角度稳定植入物的可用性有助于这些患者实现可预测的愈合和早期恢复功能。目前,横向定位锁定钢板是所有骨折类型的首选植入物。对于关节外和部分关节骨折，首选逆行植入髓内钉并提供多平面远端锁定。即使有了这些进步，股骨远端骨折内固定术后骨不连可高达19%。最近的进一步研究帮助我们了解了侧向锁定钢板固定和髓内钉的生物力学限制和愈合问题。这导致开发更坚固的构造,例如指甲板和双板构造,旨在提高构造强度并最小化故障。这些组合结构的早期结果在高风险情况下显示出希望，例如骨折伴广泛的干phy端断裂，骨质疏松症和假体周围骨折。然而，这些结构，有过度僵硬的风险，如果不保持平衡，可能会抑制愈合。骨折愈合所需的理想刚度尚不清楚，并且该领域的当前研究已导致智能植入物的发展，这些智能植入物有望发展并可能有助于改善未来的临床结果。
