Distal femoral fractures account for 5%–7% of adult long-bone injuries and present
significant treatment challenges due to comminution, soft-tissue damage, and the need
for precise articular reconstruction. The Swashbuckler approach—an anterolateral,
quadriceps-sparing exposure—offers broad visualization of both femoral condyles
while preserving future arthroplasty planes. This systematic review aimed to evaluate
the functional, radiological, and complication outcomes of the Swashbuckler
approach in adult AO/OTA Type C distal femoral fractures, and to compare these
outcomes with those reported for alternative surgical exposures. A comprehensive
search of eight databases and grey literature sources was conducted from 2015 to
2025. Studies were included if they involved patients aged ≥16 years with AO/OTA
33-C1 to C3 fractures treated via Swashbuckler or mini-Swashbuckler approach using
open reduction and internal fixation (ORIF), with reported quantitative outcomes.
Eleven studies met the inclusion criteria, with a mean patient age of 39.0 years and
69.1% being male. AO Type C2 and C3 fractures comprised 67.5% of cases. Union
was achieved in 98.9% of patients by an average of 17.2 weeks. Functional outcomes
were excellent or good in 66.5% of cases, with a mean Knee Society Score of
83.7 ± 11.9. The overall complication rate was 12.9%, most commonly superficial
infection (5.7%) and knee stiffness (4.1%). One comparative study showed superior
range of motion and Neer scores for the Swashbuckler approach versus standard
lateral exposure. Although most evidence is Level III, the Swashbuckler approach
appears to offer reliable union, acceptable complications, and favorable functional
outcomes, particularly in complex fractures. |
