A modified anterolateral swashbuckler approach for distal femoral fractures: description and outcomes: The modified swashbuckler approach for distal femoral fractures

A modified anterolateral swashbuckler approach for distal femoral fractures: description and outcomes

The modified swashbuckler approach for distal femoral fractures

Authors

Keywords:

distal femur fracture; swashbuckler approach; open reduction internal fixation;

Abstract

Background: The treatment of distal femur fractures represents a challenging task. General and local factors, including bone quality, articular surface involvement, fracture comminution, associated soft tissue injuries and ultimately fixation system, all play a role in the final clinical outcome. Current surgical approaches often undermine patellar vascularization and integrity of the extensor apparatus, not guaranteeing sufficient visualization of the medial condyle. This technical note presents the efficacy and safety a new surgical technique to address distal femoral fractures.
Methods: The original "swashbuckler" surgical approach was modified in order to obtain a better visualization of the lateral and medial femoral condyles without affecting the knee extensor mechanism and the anastomotic arterial supply of the patella. This modified surgical approach was utilized in a consecutive series of patients presenting with an AO Foundation/Orthopaedic Trauma Association (AO/OTA) 33 distal femur or periprosthetic fracture of the knee. The final outcome was recorded according to a functional evaluation scoring system.
Results: Twelve patients (2 males and 10 females) with a mean age of 67,8 years were included in this series. The same, modified "swashbuckler" surgical approach was applied in all cases. Multiple internal fixation techniques, including a single lateral plate, a combination of a lateral and medial plate, a single lateral plate associated with lag screws, were used to obtain a satisfactory stabilization of the fracture site. All patients were reviewed at a minimum one-year follow up (median 15 months): all patients regained their level of activities of daily living. No major intraoperative or postoperative complications were recorded.
Conclusions: The modified swashbuckler approach allows anatomical reduction and appropriate fixation without sacrificing the blood supply to the patella and ensures rapid weight bearing resumption thanks to an intact extensor mechanism.

References

Baumgarten KM, Mont MA, Rifai A, Hungerford DS (2001) Atraumatic osteonecrosis of the patella. Clin Orthop Relat Res Lippincott Williams and Wilkins 191–196

Beltran MJ, Blair JA, Huh J, Kirby JM, Hsu JR (2013) Articular exposure with the swashbuckler versus a “mini- swashbuckler” approach. Injury Elsevier Ltd 44:189–193

Bogunovic L, Cherney SM, Rothermich MA, Gardner MJ (2013, April) Biomechanical Considerations for Surgical Stabilization of Osteoporotic Fractures. Orthop. Clin. North Am. Orthop Clin North Am

Browner BD , Jupiter JB , Kretteck C AP. (2020) Principles of Internal Fixa- tion. Skeletal Trauma: Basic Science, Management, and Reconstruction. 6th ed. Elsevier, Philadelphia, PA

C H Rorabeck RDAPLL (1998) Fractures of the femur, tibia, and patella after total knee arthroplasty: decision making and principles of management - PubMed. Instr Course Lect 47:449–458

Chun KC, Kweon SH, Nam DJ, Kang HT, Chun CH (2019) Tibial Tubercle Osteotomy vs the Extensile Medial Parapatellar Approach in Revision Total Knee Arthroplasty: Is Tibial Tubercle Osteotomy a Harmful Approach? J Arthroplasty Churchill Livingstone Inc. 34:2999–3003

Consigliere P, Iliopoulos E, Ads T, Trompeter A (2019) Early versus delayed weight bearing after surgical fixation of distal femur fractures: a non-randomized comparative study. Eur J Orthop Surg Traumatol Springer-Verlag France 29:1789–1794

Daroch MS, Vashisht D, Sreen S (2017) Management of intra-articular fracture of distal femur with LCP and Lag screws in adults. Int J Res Med Sci 5:1434

DeBell H, Pinter Z, Pinto M, Bergstresser S, Lee S, de Cesar Netto C, Shah A, Naranje S, Agarwal AK (2019) Vascular supply at risk during lateral release of the patella during total knee arthroplasty: A cadaveric study. J Clin Orthop Trauma Operating Company Elsevier B.V. 10:107–110

Dugan TR, Hubert MG, Siska PA, Pape HC, Tarkin IS (2013) Open supracondylar femur fractures with bone loss in the polytraumatized patient - Timing is everything! Injury Injury 44:1826–1831

Ebraheim NA, Kelley LH, Liu X, Thomas IS, Steiner RB, Liu J (2015) Periprosthetic Distal Femur Fracture after Total Knee Arthroplasty: A Systematic Review. Orthop Surg 7:297–305

Elsoe R, Ceccotti AA, Larsen P (2018) Population-based epidemiology and incidence of distal femur fractures. Int Orthop Springer Verlag 42:191–196

GH Marcy (1947) The posterolateral approach to the femur - PubMed. J Bone Jt Surg Am 29:676–678

Gupta GK, Jacob RV (2020) Demographic profile and functional outcome following fixation of distal femur fractures by locking compression plate. Int J Orthop Sci 6:79–82

Harna B, Goel A, Singh P, Sabat D (2017) Pediatric conjoint Hoffa’s fracture: An uncommon injury and review of literature. J Clin Orthop Trauma Delhi Orthopedic Association 8:353–354

Jennison T, Divekar M (2019) Geriatric distal femoral fractures: A retrospective study of 30 day mortality. Injury Elsevier Ltd 50:444–447

Von Keudell A, Shoji K, Nasr M, Lucas R, Dolan R, Weaver MJ (2016) Treatment options for distal femur fractures. J. Orthop. Trauma Lippincott Williams and Wilkins

Khalil AES, Ayoub MA (2012) Highly unstable complex C3-type distal femur fracture: Can double plating via a modified Olerud extensile approach be a standby solution? J Orthop Traumatol 13:179–188

Khlopas A, Samuel LT, Sultan AA, Yao B, Billow DG, Kamath AF (2019) The Olerud Extensile Anterior Approach for Complex Distal Femoral Fractures: A Systematic Review. J Knee Surg 1

Larsen P, Ceccotti AA, Elsoe R (2020) High mortality following distal femur fractures: a cohort study including three hundred and two distal femur fractures. Int Orthop Springer 44:173–177

Lazaro LE, Cross MB, Lorich DG (2014) Vascular anatomy of the patella: Implications for total knee arthroplasty surgical approaches. Knee Elsevier B.V. 21:655–660

Marsh JL, Slongo TF, Agel J, Broderick JS, Creevey W, DeCoster TA, Prokuski L, Sirkin MS, Ziran B, Henley B, Audigé L (2007) Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association Classification, Database and Outcomes Committee. J. Orthop. Trauma Lippincott Williams and Wilkins

Mirick Mueller GE (2019) Nail-Plate Constructs for Periprosthetic Distal Femur Fractures. J Knee Surg Georg Thieme Verlag 32:403–406

Nicholls RL, Green D, Kuster MS (2006) Patella intraosseous blood flow disturbance during a medial or lateral arthrotomy in total knee arthroplasty: A laser Doppler flowmetry study. Knee Surgery, Sport Traumatol Arthrosc 14:411–416

Noorpuri BSW, Maqsood M (2002) Osteonecrosis of the patella and prosthetic extrusion after total knee arthroplasty. J Arthroplasty Churchill Livingstone Inc. 17:662–663

Peschiera V, Staletti L, Cavanna M, Saporito M, Berlusconi M (2018) Predicting the failure in distal femur fractures. Injury Elsevier Ltd 49:S2–S7

Piedade SR, Pinaroli A, Servien E, Neyret P (2008) Tibial tubercle osteotomy in primary total knee arthroplasty: A safe procedure or not? Knee Knee 15:439–446

Putman S, Boureau F, Girard J, Migaud H, Pasquier G (2019, February 1) Patellar complications after total knee arthroplasty. Orthop. Traumatol. Surg. Res. Elsevier Masson SAS

R Sanders MSHRDH (1991) Double-plating of comminuted, unstable fractures of the distal part of the femur - PubMed. J Bone Jt Surg Am 73:341–46

Della Rocca GJ, Leung KS, Pape HC (2011) Periprosthetic fractures: Epidemiology and future projections. J Orthop Trauma J Orthop Trauma

Rollick NC, Gadinsky NE, Klinger CE, Kubik JF, Dyke JP, Helfet DL, Wellman DS (2020) The effects of dual plating on the vascularity of the distal femur. Bone Jt J British Editorial Society of Bone and Joint Surgery 102 B:530–538

S Olerud (1972) Operative treatment of supracondylar--condylar fractures of the femur. Technique and results in fifteen cases - PubMed. J Bone Jt Surg Am 54:1015–32

Sain A, Sharma V, Farooque K, V M, Pattabiraman K (2019) Dual Plating of the Distal Femur: Indications and Surgical Techniques. Cureus 11

Sanchis-Alfonso V (2008) Patellofemorale schmerzen. Orthopade Orthopade 37:835–840

Schüttrumpf JP hilip., Behzadi C, Balcarek P, Walde TA lexande., Frosch S, Wachowski MM ichae., Stürmer KM ichae., Frosch KH (2013) Radiologically hyperdense zones of the patella seem to be partial osteonecroses subsequent to fracture treatment. J Knee Surg J Knee Surg 26:319–326

Shin YS, Kim HJ, Lee DH (2017) Similar outcomes of locking compression plating and retrograde intramedullary nailing for periprosthetic supracondylar femoral fractures following total knee arthroplasty: a meta-analysis. Knee Surgery, Sport Traumatol Arthrosc Springer Verlag 25:2921–2928

Singh R, Singh RB, Mahendra M (2017) Functional outcome of isolated hoffa fractures treated with cannulated cancellous screw. Malaysian Orthop J 11:20–24

Starr AJ (1998) The “swashbuckler”: A modified anterior approach for fractures of the distal femur. J Orthop Trauma Lippincott Williams and Wilkins 13:138–140

Steinberg EL, Elis J, Steinberg Y, Salai M, Ben-Tov T (2017) A double-plating approach to distal femur fracture: A clinical study. Injury Elsevier Ltd 48:2260–2265

Stevens JM, Clement ND, Macpherson G, Patton JT (2018) Comparison of two extensile approaches to the knee: a cadaveric study evaluating quadriceps snip and extensile medial parapatellar approach. J Orthop Reed Elsevier India Pvt. Ltd. 15:416–419

Tarrant SM, Balogh ZJ (2020) The Global Burden of Surgical Management of Osteoporotic Fractures. World J Surg Springer 44:1009–1019

Yaacobi E, Sanchez D, Maniar H, Horwitz DS (2017) Surgical treatment of osteoporotic fractures: An update on the principles of management. Injury Elsevier Ltd 48:S34–S40

Zonnenberg CBL, Lisowski LA, van den Bekerom MPJ, Nolte PA (2010, September) Tuberositas osteotomy for total knee arthroplasty: a review of the literature. J. Knee Surg. J Knee Surg

Downloads

Published

14-03-2022

Issue

Section

ORIGINAL ARTICLES

How to Cite

1.
Touloupakis G, Ghirardelli S, Theodorakis E, Antonini G, Violante B, Indelli PF. A modified anterolateral swashbuckler approach for distal femoral fractures: description and outcomes: The modified swashbuckler approach for distal femoral fractures. Acta Biomed [Internet]. 2022 Mar. 14 [cited 2024 Jul. 17];93(1):e2022005. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/12091