Closed management of distal femoral fractures.

Since closed treatment is effective in 80% to 85% of distal femoral fractures, operative intervention is not recommended. Unnecessary surgery produces unwarranted complications. The cast-brace technique should be used in the first week or two after injury to prevent deformities commonly associated with distal femoral fractures. The thigh cast should be carefully molded well over the femoral condyles. Distal femoral traction is preferred to proximal tibial traction to correct fracture deformities. If the closed reduction technique is not satisfactory in the early period after injury, operative intervention can still be readily accomplished. Percutaneous pin fixation of the condyles or intramedullary load-sharing devices are the treatment of choice for the very limited number of fractures that require open reduction and internal fixation.