Fixation of Periprosthetic Femur Fractures Above Total Knee Arthroplasty With the Less Invasive Stabilization System: A Midterm Follow-Up Study

Abstract

We found that a minimally invasive, locked plating system permitted stable fixation, early knee motion with good midterm results, and minimal complications. These techniques should be used in place of less stable and more invasive methods.

Fixation of Periprosthetic Supracondylar Femur Fractures Above Total Knee Arthroplasty – The Indirect Reduction Technique with the Condylar Blade Plate and the Minimally Invasive Technique with the LISS

“…Many factors must be considered in choosing the most appropriate management method for these fractures including the patients general health, prefracture ambulatory status, fracture pattern, location, displacement, and type of implant (Su et al, 2004). Periprosthetic fractures above total knee arthroplasties have particular risks for failure, including wide metaphyseal and diaphyseal spaces, osteoporosis, small distal femoral fragments, and prosthetic anchorage pegs reducing the sites for fixation (Kolb et al, 2010). Surgical options include intramedullary devices, condylar buttress plates and, -more recently, -locking plates (internal fixators) that are typically placed in a submuscular manner (Herrera et al, 2008).…”

“…The intercondylar distance must be at least 11mm or 12 mm to accommodate the nail, and the knee flexion must be at least 60° (Diehl et al, 2006;Kolb et al, 2010;Rolston et al, 1995). Small distal fragments should have enough space for at least two screws (Diehl et al, 2006, Kolb et al, 2010. Many systems include an interference screw that can be placed in the most distal screw hole to convert the nail to a fixed-angle device (Horwitz & Kubiak, 2010).…”

“…Problems associated with the use of a retrograde nail include malalignment due to a poor starting point, flexion malalignment as a result of the knee flexion required for access to the joint during reaming and nail placement, and insufficient distal stability (Horwitz & Kubiak, 2010). The intercondylar distance must be at least 11mm or 12 mm to accommodate the nail, and the knee flexion must be at least 60° (Diehl et al, 2006;Kolb et al, 2010;Rolston et al, 1995). Small distal fragments should have enough space for at least two screws (Diehl et al, 2006, Kolb et al, 2010.…”

“…Locked plate fixators improved the stability of plate osteosynthesis significantly Kolb et al, 2010). The combination of locked plate fixators and the MIPO technique allows for plate osteosynthesis without bone grafts Kolb et al, 2010). The aim of this report is to describe new planning methods and new techniques of internal fixation for supracondylar femur fractures above total knee arthroplasty.…”

“…Minimally invasive plate osteosynthesis (MIPO) have been introduced to go one step further (Krettek et al, 1997). Locked plate fixators improved the stability of plate osteosynthesis significantly Kolb et al, 2010). The combination of locked plate fixators and the MIPO technique allows for plate osteosynthesis without bone grafts Kolb et al, 2010).…”