Overview
Distal femur fractures occur just above the knee. They commonly follow high-energy trauma in younger patients and low-energy falls in older, osteoporotic patients. Many patterns cross into the knee joint surface.
Non-operative treatment rarely holds alignment in these fractures. Surgery allows the limb to be brought back to length and rotation, the joint surface to be reconstructed, and early motion started, which is especially important for knee function.
Why it's done
Distal femur ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Displaced or comminuted fracture
Closed methods cannot reliably maintain alignment.
Intra-articular extension
Joint surface step-off accelerates knee arthritis.
Periprosthetic fracture above a knee replacement
Special fixation techniques are required to protect the implant.
Open fracture
Open injuries require urgent washout and stabilization.
Inability to tolerate prolonged non-weight-bearing
Surgery allows earlier mobilization.
How it works
For extra-articular or simple intra-articular patterns, a retrograde intramedullary nail can be passed through a small incision at the front of the knee. For complex intra-articular fractures, a pre-contoured lateral locking plate is applied through a longer incision on the outside of the thigh.
The joint surface is reconstructed first with lag screws, and then the reconstructed block is connected to the femoral shaft with the plate or nail. Fluoroscopy confirms length, rotation, and alignment.
Recovery
Most patients are kept toe-touch or partial weight-bearing in the early phase, with the exact duration depending on the fracture pattern. Knee motion begins early with a continuous passive motion machine or formal therapy to prevent stiffness. Union is confirmed on X-ray as healing progresses. Periprosthetic fractures and highly comminuted patterns may take longer. Hardware is rarely removed.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes a non-union or mal-union at the end of the femur that leaves the knee malaligned and unable to bear load. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before distal femur orif include:
- bleeding and infection
- anesthesia risk
- blood clot (DVT/PE)
- stiffness (the distal femur is among the stiffest fractures to rehabilitate)
- non-union or mal-union
- hardware failure
- post-traumatic arthritis
The indication to proceed is a displaced distal femur fracture, including periprosthetic patterns around a knee replacement. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: