Supracondylar Femoral Fracture Following Total Knee Arthroplasty

Moran, Michael C.; Brick, Gregory W.; Sledge, Clement B.; Dysart, Stanley H.; Chien, Eric P.

doi:10.1097/00003086-199603000-00023

Cited by 99 publications

(36 citation statements)

References 8 publications

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“…However, maintenance of fracture reduction with standard plating methods has proven difficult and has often required extensile approaches with extensive soft tissue dissection. Fixation often fails and the risk of nonunion, further surgery, and infection tends to be high [9,16]. Recent advances in locking plating technology hold particular benefits for osteoporotic bone and can be attempted through a minimally invasive approach, which has led to several publications with acceptable results [1,13,18].…”

Section: Discussionmentioning

confidence: 99%

“…Nonoperative treatment may be appropriate for some patients who are poor surgical candidates or present with undisplaced fractures and a stable prosthesis [7,8] and regimes include traction, casts, or bracing. However, because of poor reported outcomes, the vast majority of displaced fractures warrant surgical intervention [5,16]. Multiple techniques have been proposed including: blade plates, dynamic condylar screw and plate, condylar buttress plates [9,25], Rush pins [19], Enders nails [11], and external fixation [22].…”

Section: Introductionmentioning

confidence: 99%

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Supracondylar periprosthetic femoral fractures following total knee arthroplasty: treatment with a retrograde intramedullary nail

Chettiar

Jackson

Brewin

et al. 2008

International Orthopaedics (SICOT)

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Total knee replacement surgery is occasionally complicated by a supracondylar periprosthetic fracture, and this presents a challenging problem in an often frail population. Multiple nonoperative and operative treatments have been described which have the aim of restoring the patient to their pre-injury status. This study retrospectively reviews the results of the largest series to date of 14 such fractures treated by retrograde intramedullary supracondylar nailing and is supportive of its continued use with good functional outcomes, low complication rates, and 100% fracture union.Résumé Les prothèses totales du genou peuvent être occasionnellement compliquées par une fracture supra condylienne. De nombreuses méthodes thérapeutiques ont été décrites avec le but de restaurer l'état des patients avant la fracture. Une étude rétrospective sur une très large série de 14 fractures traitées par clous intramédullaires rétro-grades ont permis de mettre en évidence un devenir fonctionnel et un taux de complications très bas ainsi qu'un taux de consolidation de 100%.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Supracondylar periprosthetic femoral fractures following total knee arthroplasty: treatment with a retrograde intramedullary nail

Chettiar

Jackson

Brewin

et al. 2008

International Orthopaedics (SICOT)

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“…Stable fractures of the distal femur with acceptable alignment can be managed with cast or brace immobilization and protected weight bearing, followed by range of motion exercises [23]. Close radiographic observation is required and surgical intervention may be necessary if subsequent displacement is observed.…”

Section: Non-operative Treatmentmentioning

confidence: 99%

Periprosthetic Distal Femur Fractures: Review of Current Treatment Options

Head

2018

ReconRev

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The geriatric population in general and specifically recipients of total knee arthroplasty (TKA) have increasing functional demands along with an increasing life expectancy. Certain intraoperative aspects of the index procedure, revision TKA, or the patient's physiology (i.e.-osteoporosis, rheumatoid arthritis, neurologic disease) predispose the patient to post-operative periprosthetic distal femur fractures (PDFF). This review describes the epidemiology, classification, examination, and treatment options of PDFF. Osteoporosis and intraoperative anterior femoral cortex notching are primary patient and surgeon specific factors, respectively. The two most commonly used classification systems were described by Rorabeck and Kim and should be used to guide the surgeon's choice of treatment. The non-operative treatment of PDFF is rare, requires close radiographic follow up, and delayed union is common. Open reduction with internal fixation (ORIF) is best accomplished with minimally invasive techniques and distal locking screws. Retrograde, intra-medullary nail fixation is technically difficult, but provides earlier weight bearing and comparable time to union as ORIF. Revision TKA is indicated in patients with adequate bone stock, a simple fracture pattern without ligamentous instability, and a loose or malaligned femoral component. Allograftprosthetic composite (APC) or distal femoral replacement (DFR) is indicated for patients presenting with a PDFF about poor or deficient bone stock. Patients with PDFF present a challenge to the arthroplasty surgeon in regards to choice of treatment and increased morbidity and mortality post-operatively. Close follow up is required and fracture union is often delayed.

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“…The blade can therefore, be placed closed to the lugs of the femoral component and close to the anterior femoral flange (Healy et al, 1993). Usually, the entry site for the blade chisel is at a height of 2.5-3 cm above the prosthetic joint line, depending on the configuration of the fracture and the prosthetic design (Moran et al, 1996). However, the angled 95° condylar blade plates do not provide sufficient stability in osteoporotic bone and might interfere with the fixation lugs of www.intechopen.com the femoral component, and the polymethylmethacrylate (Zehntner & Ganz 1993, Chen et al 1994.…”

Section: Coventional Plate Osteosynthesismentioning

confidence: 99%

“…Interprosthetic femoral fractures tend to occur more frequently in the supracondylar region above total knee arthroplasty components (Mamczak et al, 2010). Predisposing factors are female gender, poor bone stock, rotationally constrained implants, stress risers such as screw holes around the knee, malalignment of the prosthesis, endosteal ischaemia (bone cement, spongiosa preparation), anterior femoral notching, arthrofibrosis, chronic steroid use, rheumatoid arthritis, revision total knee arthroplasties, poliomyelitis and Parkinson's disease (Table 1, Aaron & Scott, 1987;Ayers, 1997;Berry, 1999;Bogoch et al, 1987;Cain et al, 1986;Cordeiro et al, 1990;Culp et al, 1987;Diehl et al, 2006;DiGioa et al, 1991;Figgie et al, 1990;Haddad et al, 1999;Hirsh et al, 1981;Lesh et al, 2000;Merkel et al, 1986;Moran et al, 1996;Ritter et al, 1988;Roscoe et al, 1989;Shawen et al, 2003;Short et al, 1981;Sisto et al, 1985;Wick et al, 2004;Zehntner & Ganz, 1993). A biomechanical study has shown that notching of the anterior cortex significantly lessens the load to failure by decreasing the bending strength by 18% and the torsional strength by approximately 40% (Lesh et al, 2000).…”

Section: Introductionmentioning

confidence: 99%