Locked compression plating versus retrograde intramedullary nailing in the treatment of periprosthetic supracondylar knee fractures: a systematic review and meta-analysis

Abstract

Background Periprosthetic fractures of the distal femur above a total knee arthroplasty (TKA) have traditionally been managed by locking compression plating (LCP). This technique is technically demanding and is associated with high rates of non-union and revision. More recently, retrograde intramedullary nailing (RIMN) has been proposed as an acceptable alternative. This meta-analysis aims to evaluate clinical outcomes in patients with periprosthetic supracondylar femoral fractures who were treated with LCP and RIMN. Methods An up-to-date literature search was carried out using the pre-defined search strategy. All studies that met the inclusion criteria were assessed for methodological quality with the Cochrane’s collaboration tool. Operative time, functional score, time-to-union, non-union rates and revision rates were all considered. Conclusion Ten studies with a total of 531 periprosthetic fractures were included. This meta-analysis has suggested that there is no significant difference in any of the outcome measures assessed. Further, more extensive literature is required on the subject to draw more robust conclusions.

Treatment of distal femur fractures with retrograde intramedullary nailing utilizing a tibial nail

“…The KSS scores of the patients after RIMN with a femoral nail for distal femur fractures range between 70 to 80. The mean KSS score in this study was consistent with the previous literature (12) and the use of a tibial nail did not end up with an inferior outcome.…”

Nail diameter significantly impacts stability in combined plate-nail constructs used for fixation of supracondylar distal femur fractures

“…[12][13][14][15] While small differences could be identified in biomechanical and clinical studies, pooled data suggests that there is no discernable difference between the 2 treatment types. [16] Recently, several authors have supported the application of combined PN constructs for use in challenging supracondylar fractures such as those with poor-quality or osteoporotic bone, a short distal segment, nonunion, malunion, or peri-implant lesions. [1][2][3] In these situations, fixation strength and rigidity may help prevent loss of alignment and improve healing.…”

Treatment of periprosthetic supracondylar fractures after CR total knee arthroplasty with retrograde intramedullary nailing in an elderly population: a long term evaluation

“…If considering plating the less invasive stabilization system with cerclage wiring and the use of a polyaxial locking plate is the preferable technique today with regard to soft tissue preservation, but requires an experienced surgeon and is more difficult to perform in complex fractures. 27,28 Biomechanical studies have shown that for PSF after TKA, RIMN can guarantee greater stability in patients with a posterior cruciate ligament retaining femoral TKA component 8 and this technique may improve the rate of the union while decreasing soft-tissue trauma. 1 Makinen et al 10 compared biomechanical results of locking plates and retrograde intramedullary nails in periprosthetic supracondylar fractures of the distal femur.…”