The authors report the case of a patient (amateur motocross competitor) who suffered a fall during a motocross competition resulting in a supra and intracondylar open fracture in the right femur.Os autores apresentam o relato de um caso de uma paciente (atleta amador de motocross) que sofreu uma queda durante uma competição e teve fratura supra e intracondiliana exposta de fêmur direito.Universidade Federal de São Paulo (UNIFESP) Departamento de Ortopedia e Traumatologia Centro de Traumatologia do EsporteHospital e Maternidade Assunção Departamento de Ortopedia e TraumatologiaUNIFESP, Depto. de Ortopedia e Traumatologia Centro de Traumatologia do EsporteSciEL

Carvalho, Rogerio Teixeira de

Cheng, Wu Tu

Cohen, Moises

Matsuda, Marcelo Mitsuro

Nicolini, Alexandre

Sayum Filho, Jorge

Sayum, Jorge

Revista Brasileira de Ortopedia

ABSTRACTThe authors report the case of a patient (amateur motocross competitor) who suffered a fall during a motocross competition resulting in a supra and intracondylar open fracture in the right femur

Filho, Jorge Sayum

de Carvalho, Rogério Teixeira

Cohen, Moisés

Elsevier - Publisher Connector 

CAsE REPORT
1 – Attending Physician at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology, Federal university of São Paulo (unifesp),  
São Paulo, SP, Brazil.
2 – Head Physician of the Department of Orthopedics and Traumatology, Assunção Hospital and Maternity Hospital (HMA), São Bernardo do Campo, SP, Brazil.
3 – Attending Physician in the Department of Orthopedics and Traumatology, Assunção Hospital and Maternity Hospital (HMA), São Bernardo do Campo, SP, Brazil.
4 – Full Professor in the Department of Orthopedics and Traumatology, unifesp; Head of the Sports Traumatology Center (CETE), São Paulo, SP, Brazil.
Work performed at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology (DOT), Federal university of São Paulo (unifesp). 
Correspondence: Rua França Pinto 186, apto. 61, Vila Mariana, 04016-001 São Paulo, SP. E-mail: jorgesayumfilho@hotmail.com
Work received for publication: July 25, 2010; accepted for publication: November 3, 2010
supRa and intRacondylaR open fRactuRe of the femuR
in a motocRoss athlete: case RepoRt
Jorge Sayum Filho1, Jorge Sayum2, Rogério Teixeira de Carvalho1, Alexandre Nicolini1, Marcelo Mitsuro Matsuda1,                          
Wu Tu Cheng3, Moisés Cohen4 
AbsTRACT
The authors report the case of a patient (amateur 
motocross competitor) who suffered a fall during 
The authors declare that there was no conflict of interest in conducting this work
This article is available online in Portuguese and English at the websites: www.rbo.org.br and www.scielo.br/rbort
INTRODUCTION
The distal femur comprises the region of the dis-
tal third of this bone. It starts where the femoral canal 
widens and the cortical bone becomes thin, and extends 
down to the joint. 
Fractures of the distal femur have bimodal incidence, 
such that they are high-energy events among young 
male adults and low-energy events among elderly wom-
en. They account for 6% of femoral fractures; 20% of 
the cases are single lesions and almost 50% of the joint 
fractures are exposed.
CAsE REPORT
The patient was a 30-year-old white man who was an 
amateur motocross competitor who was born and was 
living in São Paulo. He sought the services of the Sports 
Traumatology Center (CETE) of the Department of Or-
thopedics and Traumatology (DOT), Federal university 
of São Paulo (uNIFESP) with a complaint of pain in 
his right knee and thigh that started around one hour 
earlier, after having suffered a fall from the motorbike 
during a competition.
The patient reported that his right knee and thigh 
started to hurt one hour earlier, when he fell from his 
motorbike after jumping over an obstacle. Because of 
his intense pain and inability to get up, he was removed 
from the motocross trail by the rescue service. 
On physical orthopedic examination, the patient pre-
sented a cutting and bruising injury of 4 cm in length on 
the anterior region of the right knee and thigh; deformity 
of the thigh and severe bleeding; functional incapacity 
because of the pain; presence of a fixed splint; good 
distal perfusion; palpable peripheral pulse (4+/4+) and 
sensitivity that was difficult to assess because of the 
pain.
The clinical and surgical teams evaluated the patient 
in accordance with the principles of Advanced Trauma 
Life Support (ATLS) and released the patient. The 
vascular team evaluated the case and, after performing 
a Doppler ultrasound examination, also released the 
patient. The orthopedics team requested radiographs of 
Rev Bras Ortop. 2011;46(5):602-04
a motocross competition resulting in a supra and 
intracondylar open fracture in the right femur.
Keywords – Femoral Fractures; Fractures, Open; Athletes
© 2011 Sociedade Brasileira de Ortopedia e Traumatologia. Open access under CC BY-NC-ND license.
603
the right knee and thigh, which showed a fracture in the 
femur. For a better assessment of the fracture, computed 
tomography was also performed. In this manner, a 
diagnosis of exposed intracondylar fracture of the right 
femur was made. using the AO classification system, 
the fracture was classified as gustillo 2.33C-3.
It was decided to perform emergency surgical 
treatment. The patient was administered spinal 
anesthesia and was placed in horizontal dorsal decubitus. 
An anterior approach was chosen because the exposed 
wound was above this. With the aid of the video device, 
and after exhaustive surgical cleaning, the joint fracture 
was reduced. Following this, osteosynthesis of the joint 
fractures and then those of the metaphysis and diaphysis 
was performed with the aid of a femoral posterior 
cruciate ligament plate.
The patient remained in hospital for five days for 
intravenous antibiotic therapy (ciprofloxacin), without 
immobilization. The stitches were removed after 14 days, 
and partial progressive load-bearing was allowed from 
this time onwards. Physiotherapy, which had started on 
the second day after the operation, continued for eight 
months. At this point, the patient was discharged and 
returned to his sport. 
DIsCUssION
According to the literature, fractures of the distal 
femur have bimodal incidence, such that they are high-
energy events among young male adults and low-energy 
events among elderly females. They account for 6% of 
femoral fractures; 20% of the cases are single lesions 
and almost 50% of the joint fractures are exposed. 
The associated lesions that have been reported include 
vascular lesions in 3%, nerve lesions in 1%, lesions 
relating to the patella in 15% and ligament lesions and 
pathological conditions relating to the joint in 20 to 
70%(1-4). 
The diagnostic suspicion comes from clinical 
examination, and meticulous neurovascular examination 
is essential. Doppler ultrasound and angiography may be 
necessary. Magnetic resonance imaging and computed 
tomography are not essential, but may be necessary for 
better assessment of the fracture(2,4-6).
The classifications most used are gustillo for 
exposed fractures and AO for femoral fractures. 
Conservative treatment is only justified for patients 
who are not in a condition to undergo surgery, debilitated 
patients and cases of incomplete fractures without 
deviation. The treatment of choice is surgical, and this 
has the aims of achieving anatomical reconstruction of 
the joint surfaces, restoration of the axial and rotational 
alignment, stable fixation of the condyles to the diaphysis 
and immediate functional care. Anatomical joint 
reduction should be performed before osteosynthesis 
of the diaphyseal metaphysis. According to AO, a lateral 
approach is most recommended, but a medial anterior 
approach may also be used. A variety of osteosynthesis 
materials can be used, including: posterior cruciate 
ligament plates, laminas, DCS, LISS, external fixators 
and cannulated screws, among others(5-7). 
The classifications that exist include: axial and 
rotational misalignment, genu recurvatum, varus slide, 
dehiscence of the operative wound, stiffness, loss of 
range of motion, infection, pseudarthrosis, thrombosis 
and compartment syndrome, among others(7).
For all these reasons, this case of an exposed 
supra-intracondylar fracture of the femur in a motocross 
competitor was reported. The case was diagnosed and 
treated in accordance with the literature (Figures 1, 2 and 3). 
Figure 1 – Preoperative radiographs.
Rev Bras Ortop. 2011;46(5):602-04
SuPRA AND INTRACONDYLAR OPEN FRACTuRE OF THE FEMuR IN A MOTOCROSS ATHLETE: CASE REPORT
604
Figure 2 – Preoperative tomography.
Figure 3 – Postoperative radiographs.
Rev Bras Ortop. 2011;46(5):602-04
REFERENCEs
1. Lindvall EM. Distal Femur Fractures. In: Scott WN. Surgery Of The Knee. 
Philadelphia, United States of America: Churchill Livingstone; 2006. p. 
1119-32. 
2. Lidge RT, Problems and complications in arthroscopy. In: Casscells SW. 
Arthroscopy:diagnostic and surgical practice. Philadelphia: Lea & Febiger; 
1984. p.102-9.
3. Sprague NF.Complications in arthroscopy. New York: Raven Press; 1989.
4. Tovey C, Wyatt S. Diagnosis, investigation, and management of deep vein 
thrombosis. BMJ. 2003;326(7400):1180-4. 
5. Kearon C. Natural history of venous thromboembolism. Circulation. 
2003;17;107(23 Suppl 1):I22-30. 
6. Stassen JM, Arnout J, Deckmyn H. The hemostatic system. Curr Med Chem. 
2004;11(17):2245-60. 
7. Fitzmaurice DA, Murray E. Thromboprophylaxis for adults in hospital. BMJ. 
2007;19;334(7602):1017-8.


SUPRA AND INTRACONDYLAR OPEN FRACTURE OF THE FEMUR IN A MOTOCROSS ATHLETE: CASE REPORT 

Os autores apresentam o relato de um caso de uma paciente (atleta amador de motocross) que sofreu uma queda durante uma competição e teve fratura supra e intracondiliana exposta de fêmur direito.The authors report the case of a patient (amateur motocross competitor) who suffered a fall during a motocross competition resulting in a supra and intracondylar open fracture in the right femur

Jorge Sayum Filho

Jorge Sayum

Rogério Teixeira de Carvalho

Alexandre Nicolini

Marcelo Mitsuro Matsuda

Wu Tu Cheng

Moisés Cohen

Directory of Open Access Journals

Fratura supra e intracondiliana exposta de femur em atleta de motocross: relato de caso Supra and intracondylar open fracture of the femur in a motocross athlete: case report

Sayum Filho, Jorge [UNIFESP]

Carvalho, Rogerio Teixeira de [UNIFESP]

Nicolini, Alexandre [UNIFESP]

Matsuda, Marcelo Mitsuro [UNIFESP]

Cohen, Moises [UNIFESP]

Repositório Institucional UNIFESP

CAsE REPORT1 – Attending Physician at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology, Federal university of São Paulo (unifesp),  São Paulo, SP, Brazil.2 – Head Physician of the Department of Orthopedics and Traumatology, Assunção Hospital and Maternity Hospital (HMA), São Bernardo do Campo, SP, Brazil.3 – Attending Physician in the Department of Orthopedics and Traumatology, Assunção Hospital and Maternity Hospital (HMA), São Bernardo do Campo, SP, Brazil.4 – Full Professor in the Department of Orthopedics and Traumatology, unifesp; Head of the Sports Traumatology Center (CETE), São Paulo, SP, Brazil.Work performed at the Sports Traumatology Center (CETE), Department of Orthopedics and Traumatology (DOT), Federal university of São Paulo (unifesp). Correspondence: Rua França Pinto 186, apto. 61, Vila Mariana, 04016-001 São Paulo, SP. E-mail: jorgesayumfilho@hotmail.comWork received for publication: July 25, 2010; accepted for publication: November 3, 2010supRa and intRacondylaR open fRactuRe of the femuRin a motocRoss athlete: case RepoRtJorge Sayum Filho1, Jorge Sayum2, Rogério Teixeira de Carvalho1, Alexandre Nicolini1, Marcelo Mitsuro Matsuda1,                          Wu Tu Cheng3, Moisés Cohen4 AbsTRACTThe authors report the case of a patient (amateur motocross competitor) who suffered a fall during The authors declare that there was no conflict of interest in conducting this workThis article is available online in Portuguese and English at the websites: www.rbo.org.br and www.scielo.br/rbortINTRODUCTIONThe distal femur comprises the region of the dis-tal third of this bone. It starts where the femoral canal widens and the cortical bone becomes thin, and extends down to the joint. Fractures of the distal femur have bimodal incidence, such that they are high-energy events among young male adults and low-energy events among elderly wom-en. They account for 6% of femoral fractures; 20% of the cases are single lesions and almost 50% of the joint fractures are exposed.CAsE REPORTThe patient was a 30-year-old white man who was an amateur motocross competitor who was born and was living in São Paulo. He sought the services of the Sports Traumatology Center (CETE) of the Department of Or-thopedics and Traumatology (DOT), Federal university of São Paulo (uNIFESP) with a complaint of pain in his right knee and thigh that started around one hour earlier, after having suffered a fall from the motorbike during a competition.The patient reported that his right knee and thigh started to hurt one hour earlier, when he fell from his motorbike after jumping over an obstacle. Because of his intense pain and inability to get up, he was removed from the motocross trail by the rescue service. On physical orthopedic examination, the patient pre-sented a cutting and bruising injury of 4 cm in length on the anterior region of the right knee and thigh; deformity of the thigh and severe bleeding; functional incapacity because of the pain; presence of a fixed splint; good distal perfusion; palpable peripheral pulse (4+/4+) and sensitivity that was difficult to assess because of the pain.The clinical and surgical teams evaluated the patient in accordance with the principles of Advanced Trauma Life Support (ATLS) and released the patient. The vascular team evaluated the case and, after performing a Doppler ultrasound examination, also released the patient. The orthopedics team requested radiographs of Rev Bras Ortop. 2011;46(5):602-04a motocross competition resulting in a supra and intracondylar open fracture in the right femur.Keywords – Femoral Fractures; Fractures, Open; Athletes603the right knee and thigh, which showed a fracture in the femur. For a better assessment of the fracture, computed tomography was also performed. In this manner, a diagnosis of exposed intracondylar fracture of the right femur was made. using the AO classification system, the fracture was classified as gustillo 2.33C-3.It was decided to perform emergency surgical treatment. The patient was administered spinal anesthesia and was placed in horizontal dorsal decubitus. An anterior approach was chosen because the exposed wound was above this. With the aid of the video device, and after exhaustive surgical cleaning, the joint fracture was reduced. Following this, osteosynthesis of the joint fractures and then those of the metaphysis and diaphysis was performed with the aid of a femoral posterior cruciate ligament plate.The patient remained in hospital for five days for intravenous antibiotic therapy (ciprofloxacin), without immobilization. The stitches were removed after 14 days, and partial progressive load-bearing was allowed from this time onwards. Physiotherapy, which had started on the second day after the operation, continued for eight months. At this point, the patient was discharged and returned to his sport. DIsCUssIONAccording to the literature, fractures of the distal femur have bimodal incidence, such that they are high-energy events among young male adults and low-energy events among elderly females. They account for 6% of femoral fractures; 20% of the cases are single lesions and almost 50% of the joint fractures are exposed. The associated lesions that have been reported include vascular lesions in 3%, nerve lesions in 1%, lesions relating to the patella in 15% and ligament lesions and pathological conditions relating to the joint in 20 to 70%(1-4). The diagnostic suspicion comes from clinical examination, and meticulous neurovascular examination is essential. Doppler ultrasound and angiography may be necessary. Magnetic resonance imaging and computed tomography are not essential, but may be necessary for better assessment of the fracture(2,4-6).The classifications most used are gustillo for exposed fractures and AO for femoral fractures. Conservative treatment is only justified for patients who are not in a condition to undergo surgery, debilitated patients and cases of incomplete fractures without deviation. The treatment of choice is surgical, and this has the aims of achieving anatomical reconstruction of the joint surfaces, restoration of the axial and rotational alignment, stable fixation of the condyles to the diaphysis and immediate functional care. Anatomical joint reduction should be performed before osteosynthesis of the diaphyseal metaphysis. According to AO, a lateral approach is most recommended, but a medial anterior approach may also be used. A variety of osteosynthesis materials can be used, including: posterior cruciate ligament plates, laminas, DCS, LISS, external fixators and cannulated screws, among others(5-7). The classifications that exist include: axial and rotational misalignment, genu recurvatum, varus slide, dehiscence of the operative wound, stiffness, loss of range of motion, infection, pseudarthrosis, thrombosis and compartment syndrome, among others(7).For all these reasons, this case of an exposed supra-intracondylar fracture of the femur in a motocross competitor was reported. The case was diagnosed and treated in accordance with the literature (Figures 1, 2 and 3). Figure 1 – Preoperative radiographs.Rev Bras Ortop. 2011;46(5):602-04SuPRA AND INTRACONDYLAR OPEN FRACTuRE OF THE FEMuR IN A MOTOCROSS ATHLETE: CASE REPORT604Figure 2 – Preoperative tomography.Figure 3 – Postoperative radiographs.Rev Bras Ortop. 2011;46(5):602-04REFERENCEs1. Lindvall EM. Distal Femur Fractures. In: Scott WN. Surgery Of The Knee. Philadelphia, United States of America: Churchill Livingstone; 2006. p. 1119-32. 2. Lidge RT, Problems and complications in arthroscopy. In: Casscells SW. Arthroscopy:diagnostic and surgical practice. Philadelphia: Lea & Febiger; 1984. p.102-9.3. Sprague NF.Complications in arthroscopy. New York: Raven Press; 1989.4. Tovey C, Wyatt S. Diagnosis, investigation, and management of deep vein thrombosis. BMJ. 2003;326(7400):1180-4. 5. Kearon C. Natural history of venous thromboembolism. Circulation. 2003;17;107(23 Suppl 1):I22-30. 6. Stassen JM, Arnout J, Deckmyn H. The hemostatic system. Curr Med Chem. 2004;11(17):2245-60. 7. Fitzmaurice DA, Murray E. Thromboprophylaxis for adults in hospital. BMJ. 2007;19;334(7602):1017-8.

Supra and intracondylar open fracture of the femur in a motocross athlete: case report

file:///data/remote/core/dit/data/elsevier/pdf/801/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMjI1NTQ5NzExNTMwNDE5NQ==.pdf

Supra and intracondylar open fracture of the femur in a motocross athlete: case report

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Directory of Open Access Journals

Repositório Institucional UNIFESP

Elsevier - Publisher Connector