**6. Summary**

Distal femoral fracture management illustrates the evolution in the treatment of fractures that have significant impact on function and quality of life. New developments in fixation techniques, together with an increased understanding of the influence of mechanics in the process of fracture healing (the balance between stress and strain) has led to constant evolution in the design and selection of implants for these injuries (and combination of implants when needed). Together with a careful evaluation of the fracture pattern and the condition of the patient, the surgeon can wisely plan the best fixation method.

Distal femoral fractures, whether extra or intraarticular, with or without comminution, presenting in young, active patients (high-energy fractures and/or polytrauma) or in older patients with osteoporosis and/or knee arthritis, should be evaluated taking into account all these considerations. Selection of the surgical approach is also part of preoperative planning. Our preference for anterior, paraquadricipital approach is based on the excellent visualization of femoral condyles, metaphyseal area and proximal femoral diaphysis. In addition, it does not impede standard submuscular sliding of a lateral plate proximally and percutaneous screw fixation. Availability of diverse implants, experience of the surgical team, and dedicated, multidisciplinary care for appropriate postoperative rehabilitation, are additional important factors for successful treatment of these complex injuries.
