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Objective: A digital classification system based on AO classification was adopted to study and summarize different types of floating knee injuries. Methods: One hundred cases with a floating knee injury from March 2005 to December 2020 were collected, including 74 males and 26 females with an average age of 43.74 years. The distribution of the affected limbs in there were 51 cases (51.0%) on the left and 46 cases (46.0%) on the right, as well as 3 cases (3.0%) that got bilaterally affected limbs. The femora and tibiae in this system were divided into three parts separately based on the AO classification, which was finally composed of six types after pairwise combination. The images in this study would be analyzed by using the classification to summarize the distribution rules of the classification in a floating knee injury. Results: The proportion of I-VI type injury was 42.7%(44/103) in type I, 18.4%(19/103) in type II, 9.7%(10/103) in type III, 10.7%(11/103) in type IV, 11.7%(12/103) in type V, and 6.8%(7/103) in type VI. Conclusions: The digital classification system of floating knee injury based on AO classification could classify most cases of floating knee injury and cases with open injury, which referred to a reference effectively for the selection of surgical treatment plan, and would be conducive to the future clinical classification. [ABSTRACT FROM AUTHOR]

Pelvic ring fractures may present with relevant mechanical and haemodynamic instability. Classifications of the bony or ligamentous injuries of the pelvic ring are well established. The most common classifications used analyse the injury mechanisms and the resulting instability of the pelvic ring structure. Fracture classifications should be simple and easy to use, comprehensive, and radiographically and anatomically based, resulting in a hierarchical alphanumeric order of types and subtypes and thereby allow adequate treatment decisions based on a high degree of inter- and intraobserver reliability. In 2018 a new AO/OTA pelvic ring fracture and dislocation classification was published that combined the most commonly used "historical" classification schemes, e.g. the Tile/AO classification and the classification according to Young and Burgess. Compared with these older classifications, several relevant changes were integrated in the 2018 edition. The changes between the AO/OTA 1996/2007 and 2018 classifications were analysed in detail. Overall, several problems were identified regarding the type-B pelvic ring injury classification. These changes may result in difficulties in classifying pelvic ring injuries and thereby prevent relevant comparisons between former and future clinical studies on pelvic injuries. Level of Evidence: V. [ABSTRACT FROM AUTHOR]

Abstract Objective A digital classification system based on AO classification was adopted to study and summarize different types of floating knee injuries. Methods One hundred cases with a floating knee injury from March 2005 to December 2020 were collected, including 74 males and 26 females with an average age of 43.74 years. The distribution of the affected limbs in there were 51 cases (51.0%) on the left and 46 cases (46.0%) on the right, as well as 3 cases (3.0%) that got bilaterally affected limbs. The femora and tibiae in this system were divided into three parts separately based on the AO classification, which was finally composed of six types after pairwise combination. The images in this study would be analyzed by using the classification to summarize the distribution rules of the classification in a floating knee injury. Results The proportion of I-VI type injury was 42.7%(44/103) in type I, 18.4%(19/103) in type II, 9.7%(10/103) in type III, 10.7%(11/103) in type IV, 11.7%(12/103) in type V, and 6.8%(7/103) in type VI. Conclusions The digital classification system of floating knee injury based on AO classification could classify most cases of floating knee injury and cases with open injury, which referred to a reference effectively for the selection of surgical treatment plan, and would be conducive to the future clinical classification.

Objective Three‐dimensional (3D)‐CT data is currently insufficient for classifying femoral trochanter fractures. Fracture classification based on fracture stability analysis is helpful to evaluate the prognosis of patients after internal fixation. Currently, there is a lack of fracture classification methods based on 3D‐CT images and fracture stability analysis. The aim of this study was to propose a new six‐part classification method for intertrochanteric fractures of femur based on 3D‐CT images and fracture stability analysis to improve the diagnosis rate of unstable fractures. Method From January 2009 to December 2019, 320 patients receiving intramedullary nail surgery for femoral intertrochanteric fractures at Chengdu University's Affiliated Hospital were studied retrospectively. AO and six‐part classifications were undertaken according to the 3D‐CT image data of the patients, and the stability rates of two classifications were compared. According to the six‐part classification stability criteria, the patients were divided into a stable and an unstable fracture group. The perioperative and follow‐up indicators of the two groups were statistically analyzed, and the six‐part classification's inter‐observer and internal reliability was examined. Results There were 107 men and 213 females women the 320 patients, with an average age of 79.32 ± 11.26 years and an osteoporosis rate of 55.63% (178/320). The fracture stability rate of 39.69% (127/320) was studied using a six‐part classification method. The AO classification fracture stability rate was 42.50% (136/320), with no significant difference (χ2 = 0.523, p = 0.470 > 0.05). There is no statistically significant difference between the two classification techniques in the examination of fracture stability (McNemer difference test p = 0.306 > 0.05; Kappa consistency test p 0.75, the inter‐observer ICC value was 0.921 > 0.75, and the intra‐observer and inter‐observer reliability were both good. Conclusion The six‐part classification of femoral intertrochanteric fractures based on 3D‐CT images has broader guiding relevance for femoral intertrochanteric fracture stability analysis. Clinicians will find this classification simpler and more consistent than the AO classification.

Objective: Three‐dimensional (3D)‐CT data is currently insufficient for classifying femoral trochanter fractures. Fracture classification based on fracture stability analysis is helpful to evaluate the prognosis of patients after internal fixation. Currently, there is a lack of fracture classification methods based on 3D‐CT images and fracture stability analysis. The aim of this study was to propose a new six‐part classification method for intertrochanteric fractures of femur based on 3D‐CT images and fracture stability analysis to improve the diagnosis rate of unstable fractures. Method: From January 2009 to December 2019, 320 patients receiving intramedullary nail surgery for femoral intertrochanteric fractures at Chengdu University's Affiliated Hospital were studied retrospectively. AO and six‐part classifications were undertaken according to the 3D‐CT image data of the patients, and the stability rates of two classifications were compared. According to the six‐part classification stability criteria, the patients were divided into a stable and an unstable fracture group. The perioperative and follow‐up indicators of the two groups were statistically analyzed, and the six‐part classification's inter‐observer and internal reliability was examined. Results: There were 107 men and 213 females women the 320 patients, with an average age of 79.32 ± 11.26 years and an osteoporosis rate of 55.63% (178/320). The fracture stability rate of 39.69% (127/320) was studied using a six‐part classification method. The AO classification fracture stability rate was 42.50% (136/320), with no significant difference (χ2 = 0.523, p = 0.470 > 0.05). There is no statistically significant difference between the two classification techniques in the examination of fracture stability (McNemer difference test p = 0.306 > 0.05; Kappa consistency test p < 0.001). According to the six‐part classification, fracture stability and instability group were divided into two groups. The following indicators were compared between the two groups: The surgery time (p = 0.280), fracture reduction quality (p = 0.062); function independent measurement (p = 0.075); timed up and go test (TUG) (p = 0.191), and Parker‐Palmer score (p = 0.146). Were as compared according to the six‐part classification of stable and unstable fracture groups. Perioperative blood loss (p < 0.001), the Harris score excellent and good rate (p = 0.043), fracture healing time (p < 0.001), and the entire weight‐bearing duration (p = 0.002) were statistically significant. The difference in femoral head height (FHH) (p = 0.046), the change in femoral neck shaft angle (p = 0.003), the change in medial cephalic nail length (p = 0.033), and the change in tip–apex distance (TAD) (p = 0.002) were statistically significant compared to the relevant markers of imaging stability. Fracture stability had a substantial influence on Harris ratings at 3, 6, and 12 months following surgery, according to repeated measures analysis of variance (F(1,126) = 32.604, p < 0.001). The effect of time on the Harris score was similarly significant (F(1.893,238.508) = 202.771, p < 0.001). The observer intra‐observer inter‐group correlation coefficient (ICC) value was 0.941 > 0.75, the inter‐observer ICC value was 0.921 > 0.75, and the intra‐observer and inter‐observer reliability were both good. Conclusion: The six‐part classification of femoral intertrochanteric fractures based on 3D‐CT images has broader guiding relevance for femoral intertrochanteric fracture stability analysis. Clinicians will find this classification simpler and more consistent than the AO classification. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of femur shaft fracture in a developing country and develop prevention policies considering the findings. Methodology: This retrospective epidemiological study included all patients with a femur fracture who were admitted between January 2021 and April 2023 at the orthopedic and trauma surgery department of Lady Reading Hospital, Peshawar, Pakistan. The patient's medical records were retrospectively reviewed using electronic medical records in the Hospital information system (HIS). All patients with documented femur shaft fracture who were admitted and operated on with an interlocking nail during the study period, irrespective of age, were included. Results: A total of 347 patients were identified in HMIS and were included in this study. Mean age was 31.52 ± 15.475 SD (12-91). Male to female ratio was 295:52. According to AO classification, 27 patients had 32A1 injury, 45 patients had 32A2 injury, 74 patients had 32A3 injury, 16 patients had 32B1 injury, 44 patients had 32B2 injury, 22 patients had 32B3 injury, 18 patients had 32C1 injury, 15 patients had 32C2 injury and 27 patients had 32C3 injury. Different surgical options as well as the mode of fixation were used in the management of these fractures with missing data identification in 17% of patients. Conclusion: Traumatic femur fracture are not uncommon injuries in developing countries which occur due to road traffic accidents and firearm injuries in majority of the cases. [ABSTRACT FROM AUTHOR]

Purpose: Early loss of reduction remains a challenging complication in distal radius fracture management. There are limited data on factors that correlate with early loss of reduction. The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification has become a popular way of evaluating complex fracture patterns. This study aims to determine the impact of fracture pattern, as determined by the AO classification, on restoration of intraoperative parameters, early loss of reduction, and time to fracture union in operatively treated distal radius fractures. Methods: Following IRB approval, adult patients with surgically treated acute distal radius fractures at a single level I institution were identified. Retrospective chart and radiographic review were used to obtain AO classification, postoperative radiographic parameters, early loss of reduction, time to fracture union, as well as any complications. Results: 422 patients with operatively treated distal radius fractures were included in this study. Across fracture patterns, there were no significant differences in restoration of radial height or inclination. Higher severity fracture classifications had decreased restoration of volar tilt. Overall, simple fractures (A2, C1) and partial articular fractures (B1, B2, B3) had higher rates of satisfactory alignment restoration compared to comminuted fractures (A3, C2, C3). Although there were differences in restoration of radiographic parameters, fracture type did not correlate with loss of reduction within 30 days. C type fractures correlated with increased weeks to radiographic healing. Conclusions: This study establishes that distal radius fracture pattern, as determined by the AO classification, has a significant impact on intraoperative restoration of parameters but does not correlate with early loss of reduction. Furthermore, more difficult fracture patterns may have a longer time to fracture union, but fracture type does not appear to have an effect on postoperative complications.

Background: Vertebral Column Fractures (VCF) are a major public health concern with a high mortality rate, negative social and economic effects, and substantial morbidity. Through efficient management and preventative measures based on fundamental epidemiological data, the burden of disease can be reduced. Aim and Objectives: The objectives of this research work were to represent the epidemiology of VCF and to assess the interobserver agreement of VCF identification between spine surgeons using AO classification of Computed Tomography (CT) images. Material and Methods: A total of 456 cases of C3 to L5 spinal fractures with CT were noted. Comprehensive epidemiological profile of all the patients with VCF was recorded separately and was analyzed by SPSS software. Two spine surgeons classified 375 CT scans with a single level vertebral fracture using AO classification of the spine. Kappa coefficient (k), was used to find interobserver agreement in assessing of VCF. Results: Totally 456 cases of VCF with CT scan were collected. Mean ±SD age of men was 39.93 ± 12.07 years and women was 41.85 ± 12.22 years. The number of fractures in the 41-50 years age group was dominant (27.85%, n=127). About 82.20% of the patients had sustained a single fracture. The most common level was the thoracolumbar region (T12- L1), accounting for 41.60%. Type A fractures (68.00%) were the leading type of VCF. In deciding the subtype according to AO among single fracture, current study presented a very good interobserver agreement with (k = 0.884 with p-value = 0.018). Conclusion: In summary, current study presented a very good interobserver agreement in identifying the subtypes of VCF according to AO classification and also demonstrated epidemiology of VCF in west coast of south India.

Aims: The aim of the study was to compare the functional outcome of patients with extra-articular distal one-third tibia fracture, treated with intramedullary interlocking nailing (IMILN) with those treated by minimally invasive percutaneous plate osteosynthesis (MIPPO). Settings and Design: This is a prospective study and nonprobability sampling technique. Subjects and Methods: In this study, 60 patients with distal third tibia fractures of AO classification Type 43 A1, A2, and A3 were selected, in which 30 of them were treated with IMILN and the remaining 30 were managed with MIPPO. The patients were regularly followed up, and functional outcome was measured at 4, 8, 12, and 24 weeks using a modified Klemm and Borner scoring system. Statistical Analysis Used: The data collected were subjected to data entry in MS Excel. The data were analyzed using SPSS version 20.0 using Chi-square test. Results: In our prospective study, the functional outcome of MIPPO has shown excellent outcome in 13 patients (43.3%) and good outcome in 13 patients (43.3%), fair outcome in three patients (10%), and only one patient had poor outcome (3.3%). However, in the IMILN group, excellent outcome was seen in 7 patients (23.3%) and good outcome in 15 patients (50%), fair in five patients (16.7%), and poor outcome in 3 patients (10%). Alignment of fracture was anatomical in 13 patients of MIPPO and 7 patients of IMILN. Complications such as nonunion and malunion were more in the IMILN group than MIPPO, whereas superficial wound infection and delayed union were comparable in both. Conclusions: Distal tibial fractures can be effectively treated by both intramedullary nailing and MIPPO with minimal soft tissue injury providing good-to-excellent results, whereas in our present study, we observed that MIPPO had excellent functional outcome when compared to IMILN. Although interlocking intramedullary nailing allows early weight-bearing in patients, malunion and nonunion were more frequently seen, which affects the functional outcome. Therefore, we recommend that MIPPO is considered a very effective modality of treatment in distal third tibia fractures.

Introduction: The Arbeitsgemeinschaft für Osteosynthesefragen (AO) foundation along with the Orthopaedic. Trauma Association (OTA) introduced a new classification for sternal fractures in 2018 aiming to provide greater uniformity and clinical utility for the surgical community. A previous validation study identified some critical issues such as the differentiation between type A and B fractures and localization of the fracture either in the manubrium or in the body. Due to the moderate agreement in inter- and intra-observer variability, some modifications were proposed in order to improve the performance of the classification. The aim of this study was to re-assess the inter- and intra-observer variability after adding modifications to the classification. Our hypothesis was that a significative improvement of inter- and intra-observer variability could be achieved. Material and methods: Twenty computed tomography (CT) scans of patients with sternal fractures were analyzed by six. Junior and six senior surgeons independently. Two assessments were performed with an interval of 6 weeks. The kappa (K) value was calculated in order to assess inter- and intra-observer variability. Results: The overall mean kappa value for inter-observer variability improved from 0.364 to 0.468 (p < 0.001). Inter-observer variability mean for location was 0.573 (SD 0.221) and for type was 0.441 (SD: 0.181). Intra-observer variability showed a mean of 0.703 (SD: 0.153) with a statistic significant improvement when compared to the previous study (mean 0.414, SD: 0.256, p < 0.001). Conclusions: By modifying the AO/OTA classification of sternal fractures, the inter- and intra-observer variability improved and now shows moderate to substantial agreement. [ABSTRACT FROM AUTHOR]

Abstract Background Literature lacks data on correlations between epidemiology and clinical data of patients with distal radius fractures (DRFs). Aim The aim of this study was to present a detailed epidemiologic survey of a large consecutive series of patient with DRFs. Materials and Methods This retrospective study included 827 consecutive patients (579 females, 248 men) who sustained a DRFs in the last 5 years. All fractures were radiographically evaluated. DRFs were classified according to Association of Osteosynthesis classification. Data on age, gender, side, period in which fracture occurred, and fracture mechanism were collected. Statistical analysis was performed. Results The patients’ mean age was 60.23 [standard deviation (SD) 16.65] years, with the left side being most frequently involved (56.1%). The mean age of females at the time of fracture was significantly higher than that of males. The most frequent pattern of fracture was the complete articular fracture (64.3%), while the most represented fracture type was 2R3A2.2 (21.5%). Regarding the period in which the fracture occurred, 305 DRFs (37.5%) were observed in the warmer months and 272 (33.4%) in the colder months. Low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year. In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p 45 years. A significant correlation between all trauma mechanisms (from 1 to 6) and different fracture patterns (complete, partial, and extraarticular) was found (p value

Purpose: Tibial plateau fractures continue to be a challenging task in clinical practice and current outcomes seem to provide the potential for further improvement. Especially presurgical understanding of the orientation of fracture lines and fracture severity is an essential key to sufficient surgical treatment. The object of this study was to evaluate the reliability of modern axial CT-based classification systems for tibial plateau fractures. In addition, the diagnostic-added value of 3D printing on the classification systems was investigated. Methods: 22 raters were asked to classify 22 tibial plateau fractures (11 AO B- and 11 AO C-fractures) with the AO, the 10-Segment and the Revisited Schatzker classification in a three-step evaluation: first only using CT scans, second with 3D volumetric reconstructions and last with 3D-printed fracture models. Inter- and intraobserver agreement and the subjective certainty were analyzed. Statistics were done using kappa values, percentage match and a univariant one-way analysis of variance. Results: The AO classifications interobserver percentage match and kappa values improved for all raters and recorded an overall value of 0.34, respectively, 43% for the 3D print. The 10-Segment classification interobserver agreement also improved with the 3D-printed models and scored an overall kappa value of 0.18 and a percentage match of 79%. Equally the Revisited Schatzker classification increased its values to 0.31 and 35%. The intraobserver agreement showed a moderate agreement for the AO (0.44) and Revisited Schatzker classification (0.42) whereas the 10-Segment classification showed a fair agreement (0.27). Additionally, the raters changed their classification in 36% of the cases after evaluating the fracture with the 3D-printed models and the subjective certainty regarding the decisions improved as categories of self-reliant diagnostic choices were selected 18% (p < 0.05) more often after using the 3D-printed models. Conclusion: Based on the measured outcomes it was concluded that the new classification systems show an overall slight to fair reliability and the use of 3D printing proved to be beneficial for the preoperative diagnostics of tibial plateau fractures. The 10-Segment classification system showed the highest percentage match evaluation of all classification systems demonstrating its high clinical value across all levels of user experience. [ABSTRACT FROM AUTHOR]

Background: Vertebral Column Fractures (VCF) are a major public health concern with a high mortality rate, negative social and economic effects, and substantial morbidity. Through efficient management and preventative measures based on fundamental epidemiological data, the burden of disease can be reduced. Aim and Objectives: The objectives of this research work were to represent the epidemiology of VCF and to assess the interobserver agreement of VCF identification between spine surgeons using AO classification of Computed Tomography (CT) images. Material and Methods: A total of 456 cases of C3 to L5 spinal fractures with CT were noted. Comprehensive epidemiological profile of all the patients with VCF was recorded separately and was analyzed by SPSS software. Two spine surgeons classified 375 CT scans with a single level vertebral fracture using AO classification of the spine. Kappa coefficient (k), was used to find interobserver agreement in assessing of VCF. Results: Totally 456 cases of VCF with CT scan were collected. Mean ±SD age of men was 39.93 ± 12.07 years and women was 41.85 ± 12.22 years. The number of fractures in the 41-50 years age group was dominant (27.85%, n=127). About 82.20% of the patients had sustained a single fracture. The most common level was the thoracolumbar region (T12-L1), accounting for 41.60%. Type A fractures (68.00%) were the leading type of VCF. In deciding the subtype according to AO among single fracture, current study presented a very good interobserver agreement with (k = 0.884 with p-value = 0.018). Conclusion: In summary, current study presented a very good interobserver agreement in identifying the subtypes of VCF according to AO classification and also demonstrated epidemiology of VCF in west coast of south India. [ABSTRACT FROM AUTHOR]

Background: Literature lacks data concerning several epidemiologic aspects of isolated olecranon fractures (IOFs). The few studies that have analyzed this type of fracture show a low sample size and contradicting results. Methods: This retrospective study included 165 consecutive patients (82 men and 83 women) who sustained an IOF in the past 10 years. Participants who were aged

Background: Literature lacks data on correlations between epidemiology and clinical data of patients with distal radius fractures (DRFs).Aim: The aim of this study was to present a detailed epidemiologic survey of a large consecutive series of patient with DRFs.Materials and Methods: This retrospective study included 827 consecutive patients (579 females, 248 men) who sustained a DRFs in the last 5 years. All fractures were radiographically evaluated. DRFs were classified according to Association of Osteosynthesis classification. Data on age, gender, side, period in which fracture occurred, and fracture mechanism were collected. Statistical analysis was performed.Results: The patients' mean age was 60.23 [standard deviation (SD) 16.65] years, with the left side being most frequently involved (56.1%). The mean age of females at the time of fracture was significantly higher than that of males. The most frequent pattern of fracture was the complete articular fracture (64.3%), while the most represented fracture type was 2R3A2.2 (21.5%). Regarding the period in which the fracture occurred, 305 DRFs (37.5%) were observed in the warmer months and 272 (33.4%) in the colder months. Low-energy trauma occurring outside home was found to be the major cause of DRF throughout the year. In both genders, trauma mechanism 2 was more frequent (59.4% F; 31.9% M; p < 0.01). A bimodal distribution of fracture mechanisms was found in males when considering the patient's age with a high-energy mechanism of fracture (3 and 4), identified in 21% (n = 52) of males aged 18-45 years, and a low-energy mechanism (1 and 2) was observed in 39.9% (n = 99) of males aged > 45 years. A significant correlation between all trauma mechanisms (from 1 to 6) and different fracture patterns (complete, partial, and extraarticular) was found (p value < 0.001). The mean age of patients with extraarticular fractures (mean age 61.75 years; SD 18.18 years) was higher than that of those with complete (mean age 59.84 years; SD 15.67 years) and partial fractures (mean age 55.26 years; SD 18.31 years). Furthermore, considering different fracture patterns and patient age groups, a statistically significant difference was found (p < 0.001).Conclusions: DRFs have a higher prevalence in females, an increase in incidence with older age, and no seasonal predisposition. Low-energy trauma occurring at home is the main cause of fracture among younger males sustaining fractures after sports trauma; Complete articular is the most frequent fracture pattern, while 2R3A2.2 is most frequent fracture type.Level Of Evidence: Level IV; case series; descriptive epidemiology study. [ABSTRACT FROM AUTHOR]

Background: Distal radius and ulna fractures are the most common fracture in adults representing 44% of all fractures. Fragment-specific fixation can be a useful tool in treating distal radius fractures. Objective: The aim of the present study was to evaluate the results of treating intra-articular distal radius fractures with fragment-specific fixation to provide good functional outcome. Patients and methods: This prospective study included 36 patients with distal radial fractures. They were admitted and operated in the Casualty Unit of the Orthopedic Department, Zagazig University Hospitals. The average time of follow up period of the cases was 9 months. Results: Age was distributed as 39.5 ± 9.17 years, male were 61.1% and dominant right were in 88.9%. Mayo score distribution at different time among studied group was significant increase from 6 weeks to 3 months and to 6 months. There was significant increase in range of motion distribution from 6 weeks & 3 months to 6 months. There was significant increase in grip strength distribution from 6 weeks & 3 months to 6 months. Overall complicated cases were 6 cases. Complicated cases were significantly associated with longer union time and significant delayed return to work. Conclusion: Fragment-specific fixation is a valuable technique for intra articular distal radius fractures in well planned and selected patients. As it achieves a high rate of union and good functional outcome on follow up and it allows excellent grip strength and range of motion of wrist joint. [ABSTRACT FROM AUTHOR]

• Percutaneous fixation is a valuable option for the treatment of TL fractures. • Hardware removal after fracture healing is an option. • Fracture reduction may be easier to obtain with percutaneous fixation. Retrospective Single-Center Review of Data at a Level 1 Trauma Center. Compare deformity correction and surgical outcomes of percutaneous instrumentation and open fusion in traumatic thoracolumbar fractures. In our retrospective study, all patients undergoing elective spine surgery for TL fractures at a Level 1 trauma center between 2000 and 2017 were reviewed. Patients who underwent percutaneous fixation were given the option of hardware removal after the fracture had healed. A total of 185 patients were included in the study, with 109 treated with an open fusion, and 76 with percutaneous fixation. Twenty-five patients in the latter group had the instrumentation removed after the fracture had healed. None of them required reoperation. In the open fusion group 54.1% of patients required a decompressive laminectomy. Percutaneous fixation patients had a shorter operative time (98.3 min vs 214 min, p < 0.0001), shorter length of stay (9.8 days vs 13.5 days, p = 0.04), and less blood loss (68.4 cc vs 691 cc, p < 0.001). They also had a better correction of their traumatic kyphosis after surgery (p = 0.005). Percutaneous fixation is a valuable option for the treatment of TL fractures in cases without evidence of neural compression. It is still unclear whether hardware removal helps prevent adjacent segment degeneration. Percutaneous fixation could allow for better reduction of the fracture with improvement of postoperative alignment. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the value of three-dimensional (3D) computed tomography (CT) scans on the interobserver and intraobserver reliability of AO/Orthopaedic Trauma Association (OTA) and Young and Burgess (YB) classifications for pelvic ring injuries. Methods: Seven reviewers (four fellowship-trained orthopaedic trauma surgeons and three fellows) independently classified 36 pelvic ring injuries using radiographs and axial two-dimensional (2D) CT scan images and then repeated this process 2 months later with the addition of 3D CT images. Interobserver and intraobserver reliability was assessed. Results: The interobserver reliability of the AO/OTA classification using 2D vs. 3D CT scans was considered fair (k 0.23, CI 0.17–0.29) vs. slight (k 0.16, CI 0.09–0.22), with no observed difference [mean difference (MD) − 0.07, CI 0.16–0.01]. The interobserver reliability of the YB classification using 2D vs. 3D CT scans was considered fair for both (k 0.37, CI 0.32–0.42, vs. 0.37, CI 0.30–0.45), with no observed difference (MD − 0.0005, CI − 0.08 to 0.08). The intraobserver reliability of the AO/OTA vs. YB classifications was considered fair (k 0.35, CI 0.26–0.44) vs. moderate (k 0.49, CI 0.40–0.57), with the YB classification having higher kappa value (MD 0.13, CI 0.01–0.26, p = 0.03). Conclusion: The addition of 3D CT scan reconstructions to radiographs and 2D CT did not improve the interobserver reliability of AO/OTA and YB classifications for pelvic ring injuries. [ABSTRACT FROM AUTHOR]

Background: There are known classifications that describe thoracolumbar (TL) burst type injury but it is unclear which have the most influence on management. Our objective is to investigate the association of classification publications with the quantity and type of the most influential articles on TL burst fractures. Methods: Web of Science was searched, and exclusion and inclusion criteria were used to extract the top 100 cited articles on TL burst fractures. The effects on type, number, and other variables were separated into four eras as defined by four major classification publications. Results: 30 out of the top 100 articles represent level 1 or 2 evidence. The most influential journal was Spine, accounting for 35 articles and 4,537 citations. The highest number of articles (53) was published between the years 1995-2005, culminating with the Thoracolumbar Injury Severity Classification Score (TLICS) paper. After 2005, there was an increase in average citations per year. Following 2013, the number of highly influential articles decreased, and systematic reviews (SRs) became a larger proportion of the literature. There was a statistically significant increase in the level of 1 and 2 evidence articles with time until the publication of TLICS. The predictive value of time for higher levels of evidence was only seen in the pre-2005 years (AUC: 0.717, 95% CI 0.579-0.855, p = 0.002). Conclusions: In 1994, two articles marked the beginning of an era of highly influential TL burst fracture literature. The 2005 TLICS score was associated with a preceding increase in LOE and productivity. Following 2005, the literature saw a decrease in productivity and an increase in systematic review/meta-analysis (SR-MAs). These trends represent an increase in scholarly discussion that led to a systematic synthesis of the existing literature after publication of the 2005 TLICS article.

Objective: The sliding hip screw (SHS) is the gold standard for the management of stable intertrochanteric (IT) fractures. However, intramedullary implants are now being increasingly used for management of unstable IT fractures especially those with a compromised or vulnerable lateral wall. Therefore, accurate classification of fracture is important to ensure proper surgical planning and choice of implant. The AO classification for IT fractures is based on plain radiographs alone and many authors have reported it to have poor inter- and intra-observer agreement. Therefore, the objectives of the study were to assess the improvement in inter- and intra-observer agreement of the AO classification after addition of CT scan to plain radiographs, to assess the change in pattern of AO classification on addition of CT scan to plain radiographs and to assess percentage of times, stable lateral wall seen on plain radiographs is classified as unstable or broken on CT scans. Method: Fifty-four patients of intertrochanteric fracture were included in study. Plain radiographs of patients were shown to three orthopedic surgeons. They were asked to document the AO classification of the fracture, and comment on the integrity of the lateral wall. Then, CT scans with 3D reconstructions of the same patients were provided along with the radiographs and they were asked to classify the fracture again. Inter- and intra-observer agreement of the AO classification based on plain radiographs alone and once CT scan with 3D reconstruction was added to the plain radiographs was determined using Kappa coefficients. Pattern of change in classification on addition of CT scan to plain radiographs was also assessed. Result: The mean kappa value for inter- and intra-observer agreement for AO classification on plain radiographs alone were 0.58 (moderate) and 0.66 (substantial), respectively. Upon addition of CT scan to plain radiographs, both improved to 0.70 (substantial) and 0.77 (substantial), respectively. The AO classification of the fracture changed 28.70% times (93 of 324 observations) upon addition of CT scan to plain radiographs. 96.77% times (90 of 93 observations) the classification was upgraded to higher group, while it was downgraded in only 3.22% times (3 of 93). 55.91% times this change was observed in AO 31 A 2 group (52 of 93 observations). In 17.59% cases (57 of 324 observations), fractures which were classified as stable (A1.1–A2.1) on radiographs alone, were reclassified as unstable (A2.2–3.3) upon addition of CT scan to plain radiographs. In 11.4% cases (37 of 324 observations), the lateral wall was classified as vulnerable or broken on CT scans where it was classified intact on plain radiographs. Conclusion: Addition of CT scans with 3D reconstructions to plain radiographs improves the intra- and inter-observer agreement of the AO classification. Addition of CT scan results in change in classification of the fracture in about one out of three cases. This most commonly happens in the AO 31 A 2 group. Most of the times, this results in the classification of fracture being upgraded. Many fractures which are initially classified as stable (A1.1–A2.1) on radiographs are reclassified as unstable (A2.2–3.3) on addition of CT scans. The lateral wall is also classified as vulnerable or broken more number of times on CT scans than plain radiographs alone. Therefore, we conclude that CT scan with 3 D reconstructions definitely helps in better pre-operative classification of intertrochanteric fractures especially in select group of fractures (AO 31 A 2) where stability and integrity of lateral wall is difficult to assess. [ABSTRACT FROM AUTHOR]

Abstract Background It is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures. Methods In this observational study, 289 consecutive patients aged ≥40 years with a distal radius fracture were included. Bone mineral density (BMD) of the hips and spine was measured by dual-energy x-ray absorptiometry (DXA), and comorbidities, medication, physical activity, smoking habits, body mass index (BMI), and history of previous fracture were registered. The distal radius fractures were classified according to the Müller AO system (AO) (type B and C regarded as most complex). Results Patients with osteoporosis (n = 130) did not have increased odds of a more complex distal radius fracture (type B + C, n = 192)) (n = vs type A (n = 92) (OR 1.1 [95% CI 0.5 to 2.3]) compared to those with osteopenia /normal BMD (n = 159). Patients with AO fracture types A or C had a higher prevalence of osteoporosis than patients with type B fracture. Conclusions Distal radius fracture patients with osteoporosis did not sustain more complex fractures than those with osteopenia/normal BMD according to the AO classification system. The AO classification of distal radius fracture cannot be used to decide which patients should be referred to DXA scan and considered for secondary fracture prevention.

Objective: To analyze the early outcomes of treatment with proximal femoral nail antirotation (PFNA) in patients with unstable intertrochanteric femoral fracture. Study Design: Retrospective cross-section study. Place and Duration of Study: Pakistan Naval Ship (PNS) Shifa Hospital Karachi, from Jan 2015 to Dec 2016. Methodology: Non-probability convenience sampling was used to include unstable intertrochanteric femoral fractures which were treated with proximal femoral nail antirotation. Outcomes were measured in terms of operating time, per-operative blood loss, postoperative weight bearing and complications. Results: A total of 35 patients were analyzed. Mean age was 69.7 years (range 48-91, standard deviation (SD) ± 2.28). There were 18 males (51.4%) and 17 females (48.6%) patients. Majority of fractures were Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) type 3-1-A-2.3 and were seen in 16 patients (45.7%). Average operative time was 39.8 minutes (range 20-85 minutes SD ± 12.38). Mean intra-operative blood loss was 27.7ml (range 15 to 45 ml SD ± 9.18). Two patients (5.7%) had superficial surgical site infection. Post-operatively 16 patients (45.7%) were mobilized full wight bearing with support and 18 patients (51.4%) were mobilized partial weight bearing. Results of current study are quite promising as all fractures subsequently healed without significant complications. Conclusion: Proximal femoral nail antirotation is asuitable implant for unstable intertrochanteric femoral fractures as it is minimally invasive, has no significant blood loss and being intra-medullary early post-opweight bearing can be started.

Abstract Background With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop. Methods Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre- and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants. Results Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p

Purpose: The ankle joint has a complex anatomy structure with many causative factors and various injury mechanisms, and the clinical presentation of ankle fractures is diverse. This study aimed to analyze the characteristics of ankle fractures by applicating three-dimensional fracture line mapping technique.Methods: A retrospective study was conducted on 228 patients with ankle fractures. Three-dimensional reconstruction was performed by CT images and the fracture reconstruction model was superimposed onto a standard model of the tibiofibula for fracture line drawing. Then the fracture lines were converted into a three-dimensional coordinate point data set. And the fracture line maps as well as the fracture line heat maps were generated in 3-Matic software and Unigraphics NX software, respectively.Results: The dense area of the fibular fracture lines was located above the tibiofibular joint ligament and wrapped obliquely around the distal fibula from the anterior edge of the fibular neck. The fibular fracture line could be divided into three categories according to the degree of denseness. The dense area of the tibial fracture line is located within the anterior tibial fornix, the anterolateral corner, and the fibular notch. The tibial fracture lines can be classified into four categories according to the density of the fracture lines. The combined medial malleolus + posterior malleolar fracture line situation was found to be not encompassed by the existing AO and Lauge-Hansen (LH) classification systems according to this classification.Conclusion: The 3D fracture line mapping technique can better reflect the distribution of ankle fracture lines and could help to establish a new ankle fracture typing system in the future.

Objective: The objective of the present study was to identify patterns of femoral diaphyseal fractures which are associated with fractures of the ipsilateral femoral neck according to the AO classification. We propose an algorithm of investigation based on plain radiographs, recognizing cases that need additional screening with computed tomography.Patients and Methods: This observational retrospective study included patients with combined diaphyseal and femoral neck fractures. These patients were retrieved from a total of 1398 patients with the diagnoses of diaphyseal fractures of the femur, who were admitted to our hospital for surgical treatment between January 2009 and October 2019. All included cases had both fractures analyzed for their geometry and were classified according to the AO Classification, seeking to find a correlation between the types of fractures.Results: Sixteen diaphyseal fractures associated with ipsilateral neck fractures were detected during the period. The distribution of the diaphyseal fractures according to the AO Classification was as follows: 5 of type A3 (31,2%) 6 type B2 (37.5%), 1 type B3 (6,2%), 2 type C2 (12,5%) and 2 type C3 (12,5%). One A2 femoral fracture occurred during the surgical procedure. No type A1 fractures were detected.Conclusion: The patterns of high-energy diaphyseal fractures (A3, B and C) have a higher prevalence of associated ipsilateral neck fractures. Our study suggests that routine additional methods of image investigation of femoral neck fractures may be unnecessary for diaphyseal fractures type A1 and A2. [ABSTRACT FROM AUTHOR]

Background/Purpose: The high prevalence of hypovitaminosis D among trauma patients have been related to risk of fractures, falls, non-union and poor operative outcomes. There is limited evidence that ties up Vitamin D levels with fracture severity. The objective of this study is to determine the association of pre-operative Vitamin D levels and fracture severity. Methods: This was a retrospective, cross-sectional study of patients with extremity fractures classified according to the AO Trauma classification system with baseline pre-operative vitamin D levels. The association between vitamin D levels and fracture severity of surgically treated trauma patients were analyzed. Sub-group analysis was performed on patients without osteoporosis and those patients who suffered from low-energy trauma. Results: Ninety-six (96) patients were included. Those with severe fractures (AO -C fractures, 31B1.3/B2.3 and 31A3) were associated with lower Vitamin D levels (µ = 17.87 µg/mL) (p < 0.001). There was a strong, positive significant correlation (rs (4) =.426, p = < 0.001) between hypovitaminosis D and increasing fracture severity. This significant association of hypovitaminosis D with worse fracture patterns remains in the patient sub-group without osteoporosis (p = 0.030), and in those who sustained low-mechanism injuries (- p- < 0.001). Conclusion: We present initial evidence that low pre-operative Vitamin D level is associated with increasing fracture severity at the time of injury. Early detection, surveillance and management of low vitamin D levels can lead to drastic changes in the holistic approach to fracture prevention and treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Several studies published over the last decade indicate an increased incidence of distal radius fractures (DRF). With Norway having one of the highest reported incidence of DRFs, we conducted a study to assess the epidemiology of DRFs and its treatment in the catchment area of Akershus University Hospital (AHUS). Methods Patients 16 years or older who presented to AHUS with an acute DRF during the years 2010 and 2011 were prospectively recorded and classified according to the AO fracture classification system. The mechanism of injury and treatment modality were noted. Results Overall, 1565 patients with an acute DRF presented to the institution in 2010–2011, of which 1134 (72%) were women. The overall annual incidence was 19.7 per 10,000 inhabitants 16 years or older. Women had an exponential increase in incidence after the age of 50, though the incidence for both genders peaked after the age of 80 years. There was an even distribution between extra- and intra-articular fractures. Falling while walking outside was the most common mechanism of injury. Of the 1565 registered, 418 (26.7%) patients underwent surgery, with a volar locking plate being the preferred surgical option in 77% of the cases. Conclusion The overall incidence of distal radius fractures was lower in our study than earlier reports from Norway. Postmenopausal women had a higher risk of fracture than the other groups, and low-energy injuries were most dominant. 26.7% were treated operatively, which is higher than earlier reports, and might reflect an increasing preference for surgical treatment.

Background: It is mechanically plausible that osteoporosis leads to more severe peripheral fractures, but studies investigating associations between BMD and radiographically verified complexity of distal radius fractures are scarce. This study aims to study the association between osteoporosis, as well as other risk factors for fracture, and the AO classification of distal radius fractures.Methods: In this observational study, 289 consecutive patients aged ≥40 years with a distal radius fracture were included. Bone mineral density (BMD) of the hips and spine was measured by dual-energy x-ray absorptiometry (DXA), and comorbidities, medication, physical activity, smoking habits, body mass index (BMI), and history of previous fracture were registered. The distal radius fractures were classified according to the Müller AO system (AO) (type B and C regarded as most complex).Results: Patients with osteoporosis (n = 130) did not have increased odds of a more complex distal radius fracture (type B + C, n = 192)) (n = vs type A (n = 92) (OR 1.1 [95% CI 0.5 to 2.3]) compared to those with osteopenia /normal BMD (n = 159). Patients with AO fracture types A or C had a higher prevalence of osteoporosis than patients with type B fracture.Conclusions: Distal radius fracture patients with osteoporosis did not sustain more complex fractures than those with osteopenia/normal BMD according to the AO classification system. The AO classification of distal radius fracture cannot be used to decide which patients should be referred to DXA scan and considered for secondary fracture prevention. [ABSTRACT FROM AUTHOR]

Objective: To analyze the early outcomes of treatment with proximal femoral nail antirotation (PFNA) in patients with unstable intertrochanteric femoral fracture. Study Design: Retrospective cross-section study. Place and Duration of Study: Pakistan Naval Ship (PNS) Shifa Hospital Karachi, from Jan 2015 to Dec 2016. Methodology: Non-probability convenience sampling was used to include unstable intertrochanteric femoral fractures which were treated with proximal femoral nail antirotation. Outcomes were measured in terms of operating time, per-operative blood loss, postoperative weight bearing and complications. Results: A total of 35 patients were analyzed. Mean age was 69.7 years (range 48-91, standard deviation (SD) ± 2.28). There were 18 males (51.4%) and 17 females (48.6%) patients. Majority of fractures were Arbeitsgemeinschaft für Osteosynthesefragen/Association for the Study of Internal Fixation (AO/ASIF) type 3-1- A-2.3 and were seen in 16 patients (45.7%). Average operative time was 39.8 minutes (range 20-85 minutes SD ± 12.38). Mean intra-operative blood loss was 27.7ml (range 15 to 45 ml SD ± 9.18). Two patients (5.7%) had superficial surgical site infection. Post-operatively 16 patients (45.7%) were mobilized full wight bearing with support and 18 patients (51.4%) were mobilized partial weight bearing. Results of current study are quite promising as all fractures subsequently healed without significant complications. Conclusion: Proximal femoral nail antirotation is asuitable implant for unstable intertrochanteric femoral fractures as it is minimally invasive, has no significant blood loss and being intra-medullary early post-opweight bearing can be started. [ABSTRACT FROM AUTHOR]

Background: With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop.Methods: Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre- and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and the use of anticoagulants.Results: Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05).Conclusions: Patients with unstable ITFs exhibited a greater hemoglobin drop and a hidden blood loss was suspected around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce associated postoperative complications, especially in patients with severe anemia or high risk of mortality. [ABSTRACT FROM AUTHOR]

Abstract The present study investigated the factors influencing the early clinical outcomes after ankle fracture surgery. We included 88 patients, who had undergone implant removal surgery at 1 year after ankle fracture surgery, with ankle computed tomographic (CT) scans obtained before ankle fracture surgery and at implant removal available. We collected demographic information, including age, sex, the presence of diabetes mellitus, level of trauma energy, and fracture classification from the medical records. We also recorded the fracture height using the radiographs and CT images. The medial joint space and articular incongruity were assessed on the follow-up radiographs and CT scans. Bone attenuation was measured by placing a circular region of interest around the ankle joint on the preoperative CT image. The postimplant removal outcomes were assessed using 2 functional questionnaires, the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale and Foot and Ankle Outcome Score (FAOS). Significant factors related to the AOFAS ankle-hindfoot scale scores and FAOS were identified through univariate analysis using age, sex, radiographic measurements, and CT findings as explanatory variables, followed by multiple regression analysis. On multiple regression analysis, the total FAOS was independently related to the AO classification (p =.003) and Lauge-Hansen classification (p =.003). The total AOFAS ankle-hindfoot scale score was related to articular incongruity (p =.044). The early clinical outcomes after ankle fracture surgery were affected by involvement of the ankle joint fracture rather than the lateral malleolus fracture height. Female sex and the presence of postoperative articular incongruity correlated with inferior early clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to verify the age-, gender- and Arbeitsgemeinschaft für Osteosynthesefragen (AO) type-specific clinical characters of adult tibial plateau fractures in 83 hospitals in China and to investigate whether altitude has potential relationships with adult tibial plateau fractures.Methods: A retrospective investigation was performed on consecutive patients with tibial plateau fractures treated in 83 hospitals in China between January 2010 and December 2011, data including age, gender and imaging were collected retrospectively through the PACS system and case reports checking system, imaging were classified into six types under fully qualified estimation based on AO classification. To further investigate imparities among different altitudes in China, all data were classified into four groups according to the centre altitudes of each city, G1 = plains group (<500 m), G2 = hills group (500-1000 m), G3 = mountain areas group (1000-2000 m), and G4 = plateau group (>2000 m). Comparison of gender distribution, age distribution and AO type were done.Results: A total of 6,227 adult tibial plateau fractures were included. Men in the age range of 40-44 years were the most affected patients, and the overall high-risk injury type was 44-B. In four groups, the same peak age showed, namely, 40-44 years in males and 55-59 years in females. Age distribution showed no statistically significant difference in four groups (P > 0.05), while sex distribution and AO type indicated statistically significant differences (P < 0.05). Note an inversion of sex ratio among people over 60 years.Conclusion: Our study showed that men in the 40-44 year age range are the most affected patients, and different sex distribution as well as injury type of adult tibial plateau fractures differed with various altitudes in China. [ABSTRACT FROM AUTHOR]

Around one third of humeral fractures and 2-6% of all fractures occur to the distal part of the humerus. There is a bimodal distribution differentiating between young male patients with high-energy and elderly female patients with low-energy trauma related to osteoporosis. The AO classification and Dubberley subclassification are used in daily routine. Most fractures are diagnosed on radiographs. For further evaluation, three-dimensional computed tomography is recommended, especially for comminuted or complex fractures. Owing to the long immobilization and resultant poor functional outcome, conservative treatment is followed for inoperable patients. The operative approach and osteosynthesis depend on the fracture pattern. In A1 avulsion fractures, open reduction and screw fixation are recommended. In A2/A3 fractures, a triceps-sparing approach following a 90° double-plate construction (radial dorsal/ulnar lateral) with locking plates is favored. Partial articular B1/B2 fractures are exposed via a medial or lateral approach using unilateral locking plates to stabilize the medial/lateral column. Coronal shear fractures (B3) are classified after Dubberley and are treated via an extended Kocher approach and headless compression screws in anteroposterior direction. If there is a further posterior comminution or a lateral column fragment, stabilization is needed for the lateral/medial column with a precontoured locking plate. In solely articular fracture patterns, a dorsal approach with either a 90° or 180° double-plate construction is advised. If a reconstruction is not possible owing to fracture complexity or bone quality, total elbow arthroplasty is a viable option. However, lifelong limitation in weight-bearing up to 5 kg, limited longevity, and the potential for complicated revision surgery should be considered. [ABSTRACT FROM AUTHOR]

Purpose: The literature lacks recent epidemiological studies on the incidence, trauma mechanism and fracture classification of distal femur fractures. The aim of the present study was to provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population and to report on the distribution of fracture classification, trauma mechanisms and patient baseline demographics.Methods: The approach for this study was via a retrospective reviews of records.Results: A total of 293 patients were treated for 302 distal femur fractures between 2005 and 2010. The mean age at the time of fracture was 62.2 years. The mean age was 44.0 years for males and 71.6 years for females. The gender distribution was 33.4% males and 66.6% females. The overall incidence of distal femur fractures was 8.7/100,000/year. After the age of 60 years, a rapid increase in the incidence of distal femoral fractures was observed in both genders, with a large female predominance. Low-energy injuries were the most common mode of injury in both genders (97%), with approximately 61% being the result of a fall from standing height. AO classification type A (extra-articular fractures) was the most common of all fractures (38.6%). Eighty-four patients (28.7%) were admitted with periprosthetic fractures, corresponding to an overall incidence of periprosthetic fractures of 2.4/100,000/year.Conclusions: The present study shows an incidence of 8.7/100,000/year of distal femur fractures. After the age of 60 years, a rapid increase in the incidence of distal femoral fractures was observed in both genders, with a considerable female predominance. [ABSTRACT FROM AUTHOR]