[Distal femoral fractures].

Fractures of the distal femur still represent injuries that are difficult to treat as they either affect younger patients after a high-energy trauma with soft tissue damage and osseous comminution or elderly people with impaired local vascularity and a poor bone stock. However, exactly these fractures profit from new, biological principles of treatment, which help to diminish additional surgical trauma by indirect fracture reduction and insertion of stabilizing implants via mini-incisions. Basically, these techniques are represented by retrograde intramedullary nails and submuscularilly inserted plates/internal fixateurs. While intramedullary nails are well suited to fix extramedullary and simple articular fractures (C1), plates can also be used to treat complex articular fractures. Nevertheless, any displaced articular fracture component must still be anatomically reduced by an open approach and fixed with absolute stability. Technical advances as well as demographic changes will continue to represent challenges in the treatment of these fractures.